CLIA Certification Reminder

Date: August 15, 2025

Attention: All Providers

Call to action: Texas Children Health Plan (TCHP) would like to remind providers that all providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendment (CLIA). To meet these requirements, providers:

Must submit their CLIA certifications.
May only bill for services that are covered under their current CLIA certification.

Medicaid will only reimburse providers for laboratory services if they:

Comply with CLIA.
Have CLIA certification for the procedure code being billed.

Note: Medicaid will not reimburse any claims for a procedure without appropriate CLIA certification.

Updating CLIA Certifications in PEMS

Providers must update their CLIA certifications during their provider enrollment revalidation in the Provider Enrollment and Management System (PEMS) by clicking the License/Certification/Accreditation tab.
For more information about updating CLIA certifications in PEMS, refer to www.tmhp.com/topics/provider-enrollment/pems/licenses.
Providers can verify their revalidation date and enrollment information in PEMS. A provider can complete their revalidation up to 180 calendar days before their revalidation due date. For more information, visit the How to Apply for Enrollment page on tmhp.com, click on Determine Your Application Type, and scroll to the Revalidation heading.

CLIA Certification Types

The following are the current CLIA certification types listed by the Centers for Medicare & Medicaid Services (CMS):

Certificate of Waiver – This certificate is issued to a laboratory to perform only waived tests.
Certificate for Provider – Performed Microscopy Procedures (PPMP) – This certificate is issued to a laboratory in which a physician, midlevel practitioner, or dentist performs no tests other than microscopy procedures. This certificate also permits the laboratory to perform waived tests.
Certificate of Registration – This certificate is issued to a laboratory that enables the entity to conduct moderate- or high-complexity laboratory testing or both until the entity is determined by survey to be in compliance with the CLIA regulations.
Certificate of Compliance – This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate of Accreditation – This certificate is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Resources:

Approved In-Office Lab List (Provider Alert)

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into: www.texaschildrenshealthplan.org/provideralerts.