CurrentMolina HealthcarePolicy N/A

Non‑Participating Laboratory COVID-19 Testing — Documentation for Medicare Member Claims

Governs documentation requirements for non-participating laboratories billing Molina Healthcare of California for COVID-19 testing of Medicare members; affects non-participating labs seeking payment for those claims.

Policy Summary

PayerMolina Healthcare

PolicyNon‑Participating Laboratory COVID-19 Testing — Documentation for Medicare Member Claims

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit CLIA certification (including Page 2 showing certification to perform COVID-19 testing) to Molina via mail, fax, or email for claims payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1required document type (CLIA)

3submission channels

42 CFR § 424.5payment qualification citation

42 USC § 263a / 42 CFR § 493.3CLIA citations

Payment Eligibility and Coverage Criteria

Policy Summary

PayerMolina Healthcare

PolicyNon‑Participating Laboratory COVID-19 Testing — Documentation for Medicare Member Claims

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit CLIA certification (including Page 2 showing certification to perform COVID-19 testing) to Molina via mail, fax, or email for claims payment.

SourceLink

On This Page

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Provider must submit CLIA certification including Page 2 demonstrating certification to perform COVID-19 testing

Documentation must be sent to Molina Healthcare, Inc. Attn: CLIA Reviewer at the provided mail, fax, or email addresses

Claims will be denied unless and until the appropriate CLIA documents are received

Provider is entitled to payment only if qualified to receive payment for the services at the time they were rendered (42 CFR § 424.5)

Under CLIA a laboratory may not perform testing on human-derived materials without a valid CLIA certification (42 USC § 263a(b); 42 CFR § 493.3(a))

Claims Submission and Documentation Actions for Providers

Documentation Required

Submit CLIA certification (including Page 2) to Molina via mail, fax, or email

Submit your CLIA certification, including Page 2 that specifically shows you are certified to perform laboratory tests for COVID-19 samples, to Molina for claims payment. Send documents via mail, fax, or email to the addresses below.

Mail: Molina Healthcare, Inc. Attn: CLIA Reviewer, 200 Oceangate, Suite 100, Long Beach, CA 90802
Fax: (855) 366-5462 (Attn: CLIA Reviewer)
Email: CA_SIU@MolinaHealthcare.com

Denial Risk

All claims denied unless required CLIA documents received

Claims will be denied until Molina receives the required CLIA documentation. Providers should not expect payment for Medicare member COVID-19 tests unless the appropriate documents are submitted and Molina confirms receipt.

Definitions

CLIA certification (definition and note about Page 2)

DefinitionCLIA certification including Page 2: documentation showing the laboratory is certified to perform laboratory tests for COVID-19 samples.

What to includePage 2 must specifically show certification to perform testing on COVID-19 samples.

PurposeRequired to establish eligibility for Molina to process and pay Medicare member COVID-19 testing claims from non-participating labs.

Consequence of missing documentAll claims will be denied unless and until the appropriate CLIA documents are received.

Non-participating laboratory (definition)

DefinitionNon-participating laboratory: a laboratory that is not contracted/participating with Molina Healthcare and bills Molina for services.

Payment eligibility noteA provider is entitled to payment only if qualified to receive payment for the services at the time they were rendered (42 CFR § 424.5).

Submission channelsDocuments must be sent to Molina Healthcare, Inc. Attn: CLIA Reviewer via mail, fax, or email at the addresses provided.

Regulatory requirementUnder CLIA, a laboratory may not perform testing on human-derived materials without a valid CLIA certification (42 USC § 263a(b); 42 CFR § 493.3(a)).

OpenPayer

Non‑Participating Laboratory COVID-19 Testing — Documentation for Medicare Member Claims

Payment Eligibility and Coverage Criteria

Required Certification (Not Procedure Codes)

Claims Submission and Documentation Actions for Providers

Definitions