Reminder: CLIA Certification Required for Claims Payment


As a reminder to our Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid providers, Texas Medicaid and Healthcare Partnership (TMHP), advises:

  • All providers that bill laboratory services must have the appropriate CLIA Certification for the services(s) being billed.
  • Reimbursement will  be denied for services billed without the appropriate certification.
  • Providers can update their CLIA certification and gather more information on the Provider Enrollment and Management System PEMS web page License/Certification/Accreditations.

Providers, for questions or additional information, please:

  • Contact Texas Medicaid and Healthcare Partnership (TMHP) at 1-800-925-9126.
  • Contact your Medicaid Provider Network Representative at 1-855-212-1615.
  • Submit via email Texas Medicaid Network Department.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty, or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations, and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.