For practice managers, lab owners, and healthcare providers, B23 denials signal a critical compliance issue: your claim indicates the test wasn’t authorized under your CLIA proficiency testing requirements. These denials disrupt cash flow, increase administrative workload, and risk revenue loss.
Here’s how to identify, prevent, and resolve B23 denials effectively.
Why B23 Denials Occur
Key triggers for B23 denials include:
- Non-CLIA-Certified Tests – The performed test falls outside your lab’s CLIA certification scope.
- Incorrect Coding – CPT/HCPCS codes don’t match your CLIA proficiency testing authorization.
- Insufficient Documentation – Missing test validation or medical necessity proof.
- Provider Eligibility Gaps – The ordering provider isn’t approved for the service.
- Contractual Misalignments – Payer agreements don’t cover the test under your CLIA status.
The Financial & Operational Impact
Ignoring B23 denials leads to:
- Revenue Leakage: Unresolved claims mean lost reimbursements.
- Resource Drain: Staff waste hours reprocessing denials.
- Compliance Risks: Repeated denials may trigger audits or penalties.
5 Strategies to Prevent B23 Denials
1. Audit Your CLIA Certification Scope
- Verify that all billed tests align with your CLIA proficiency testing authorization.
- Update certifications proactively when adding new tests.
2. Standardize Coding Practices
- Use CLIA-specific modifiers (e.g., QW for waived tests) where required.
- Cross-check CPT codes against payer policies.
3. Strengthen Documentation
- Ensure test requisitions include:
- Medical necessity
- Provider credentials
- CLIA certification proof
4. Conduct Pre-Submission Reviews
- Implement claim scrubbing tools to flag B23 risks before submission.
5. Train Staff & Providers
- Educate teams on CLIA proficiency testing requirements.
- Clarify ordering protocols with referring providers.
Need Help Overcoming B23 Denials?
Recurring B23 denials require expert intervention. Claims Med specializes in:
- Denial Prevention: Fix root causes like CLIA mismatches.
- Claims Recovery: Appeal and reprocess denied claims.
- Revenue Optimization: Streamline billing for maximum reimbursements.
Don’t let B23 denials cut into your profits.
📞 Contact Claims Med today to fortify your revenue cycle.