Denial Code B23 means that a claim has been denied because the procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Below you can find the description, common reasons for denial code B23, next steps, how to avoid it, and examples.
2. Description
Denial Code B23 is a specific denial code that indicates the procedure billed on the claim has not been authorized according to the Clinical Laboratory Improvement Amendment (CLIA) proficiency test. This means that the insurance company will not make the payment for the procedure because it does not meet the necessary requirements set by CLIA. In simpler terms, the claim is denied because the procedure is not authorized.
2. Common Reasons
The most common reasons for denial code B23 are:
- Lack of CLIA Certification: Providers may face Denial Code B23 if they do not have the necessary CLIA certification to perform the specific procedure. CLIA certification ensures that laboratories meet certain quality standards and proficiency requirements. Without this certification, the insurance company will deny the claim.
- Expired CLIA Certification: If a provider’s CLIA certification has expired or is not up to date, any procedures performed during that period will be denied under Code B23. It is essential for providers to maintain their CLIA certification and renew it in a timely manner to avoid denials.
- Incorrect Procedure Coding: Claims may be denied under Code B23 if the procedure code billed does not match the authorized procedures covered by the provider’s CLIA certification. It is crucial for providers to accurately code the procedures performed to ensure they align with their CLIA certification.
- Missing or Incomplete Documentation: Insufficient or incomplete documentation supporting the medical necessity of the procedure can lead to denials under Code B23. It is essential for providers to maintain thorough and accurate documentation to demonstrate the need for the procedure and its compliance with CLIA requirements.
- Non-Compliance with CLIA Regulations: Providers must adhere to CLIA regulations regarding proficiency testing and quality control. Failure to comply with these regulations can result in denials under Code B23. It is crucial for providers to stay updated on CLIA requirements and ensure compliance to avoid claim denials.
3. Next Steps
You can fix denial code B23 as follows:
- Review CLIA Certification: First, review your CLIA certification to ensure it is valid and up to date. If your certification has expired or is not in compliance, take the necessary steps to renew or update it.
- Verify Procedure Coding: Double-check the procedure codes billed on the claim to ensure they align with the procedures authorized by your CLIA certification. If there are any discrepancies, correct the coding to accurately reflect the authorized procedures.
- Improve Documentation: Enhance your documentation practices to ensure that all necessary information supporting the medical necessity of the procedure is included. This includes documenting the patient’s condition, the reason for the procedure, and any other relevant details that demonstrate compliance with CLIA requirements.
- Appeal the Denial: If you believe the denial was in error or have additional documentation to support the claim’s validity, prepare an appeal. Submit the necessary documentation and explanation to challenge the denial and provide evidence of compliance with CLIA regulations.
- Stay Updated on CLIA Regulations: Regularly review and stay updated on CLIA regulations, including proficiency testing and quality control requirements. Ensure that your laboratory is in compliance with these regulations to avoid future denials under Code B23.
4. How To Avoid It
You can prevent denial code B23 in the future as follows:
- Obtain and Maintain CLIA Certification: Ensure that your laboratory has the necessary CLIA certification to perform the procedures you bill for. Maintain the certification and renew it in a timely manner to avoid any gaps in coverage.
- Accurate Procedure Coding: Code the procedures accurately, ensuring that they align with the authorized procedures covered by your CLIA certification. Regularly review and update your coding practices to reflect any changes in CLIA requirements.
- Thorough Documentation: Maintain thorough and accurate documentation that supports the medical necessity of the procedures performed. Include all relevant information, such as the patient’s condition, the reason for the procedure, and any other details that demonstrate compliance with CLIA regulations.
- Compliance with CLIA Regulations: Stay updated on CLIA regulations and ensure that your laboratory is in compliance with proficiency testing and quality control requirements. Regularly review and update your practices to align with any changes in CLIA guidelines.
5. Example Cases
Below are two examples of denial code B23:
- Example 1: A laboratory submits a claim for a specific genetic test that requires CLIA certification. However, the laboratory does not have the necessary certification to perform the test. As a result, the claim is denied under Code B23.
- Example 2: A laboratory performs a procedure that is covered by their CLIA certification, but the procedure code billed on the claim does not match the authorized procedures. The claim is denied under Code B23 due to incorrect procedure coding.
