B23Denial Code (CARC)Active
CO B23 Denial Code - Fix Unauthorized Procedure
Code B23 indicates that the procedure you billed was not authorized based on your CLIA proficiency test. This means the lab service provided is outside the scope of what your CLIA certification permits.
Who Pays: Group Code Liability
With code B23, the liability typically falls under CO, meaning the provider must write off the charge and cannot bill the patient. Verify with the payer if there are exceptions.
Why Claims Get Code B23
- Billing a lab test that requires a higher CLIA certification than the provider holds.
- Submitting a claim for a procedure not included in the provider's CLIA certificate.
- Failure to update the CLIA certification details with the payer.
- Using an incorrect CLIA number on the claim.
- Submitting a claim for a test under a waived CLIA certification when moderate or high complexity certification is required.
How to Fix & Resubmit
- Verify the CLIA certification level required for the billed procedure.
- Check the CLIA number on the claim to ensure it matches the provider's certification.
- Contact the payer to confirm the certification mismatch details.
- Correct the CLIA number or adjust the procedure billed if possible, then resubmit the claim.
- If unable to correct the claim, write off the charge as per contractual obligation.
Corrected Claim or Appeal?
For code B23, if the CLIA certification mismatch is an error, correct the claim with the appropriate CLIA information and resubmit. If the procedure is outside your certification, an appeal is not applicable and the charge must be written off.
Preventing Future B23 Denials
- Regularly verify that all billed procedures align with your CLIA certification level.
- Update your CLIA certification details with all payers as soon as changes occur.
- Ensure the correct CLIA number is entered in billing systems for all applicable claims.
- Educate billing staff on the requirements and limitations of your CLIA certification.