Info needed from providers with lab equipment or that perform lab testing


Last June, we announced that ConnectiCare will be aligning with the Centers for Medicare & Medicaid Services (CMS) and the Federal Clinical Laboratory Improvement Amendments (CLIA) regulations that help to ensure quality laboratory testing. We published our updated Payment Policy: Laboratory/Venipuncture (Commercial and Medicare) for more details.

Under this policy, a valid Federal CLIA Certificate Identification number is required for reimbursement of clinical laboratory services reported on a CMS 1500 Health Insurance Claim Form or its electronic equivalent.

Physicians, urgent care centers or other qualified health care professionals who:

  • Own laboratory equipment (Physician Office Laboratory), and
  • Perform laboratory testing outside of CLIA-waived tests

Must submit the following to ConnectiCare:

1.    Proof of CLIA Certification of Compliance or Accreditation including the laboratory certification codes at the bottom of the CLIA Certificate.

2.    A list of tests and codes performed at the location.

Please send the information to ConnectiCare no later than Oct. 1, 2020 by:

  • Fax: 1-860-674-2849
  • Mail: ConnectiCare
            Attention: Network Operations
            P.O. Box 546
            Farmington, CT 06034-0546

If ConnectiCare does not receive this information, claims received with CPT codes on the list that require a CLIA Certification of Accreditation or Compliance may be denied starting Feb. 1, 2021.