This packet will contain forms to begin the CHOW approval process.Ĭompleted applications for New Providers or Change of Ownership should be submitted to Health Facility Services via mail, email or fax.Ĭlick here for CLIA Frequently Asked Questions. Change of Ownership Application: For existing Providers who need to notify Health Facility Services of a change in ownership.New Provider Application: This packet will contain forms to begin the process to become Medicare Certified and must be submitted to Health Facility Services.Requests for New Provider Applications (CMS116) or CHOW Applications should be submitted via mail, email or fax to the ADH Health Facility Services office, listed below. State Operations Manual, Appendix C – Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services (Federal Program):Īpplications & Change of Ownership (CHOW): The CMS CLIA website has information such as Regulations, forms, brochures, etc. The program is administered by the federally regulated Centers for Medicare & Medicaid Services (CMS) agency. Although all clinical laboratories must be properly certified to receive Medicare or Medicaid payments, CLIA has no direct Medicare or Medicaid program responsibilities. Select a Profession and enter a Credential/License Number OR. Health/Business Individual Credential/License Search.
The objective of the CLIA program is to ensure quality laboratory testing. ATTENTION: If a renewal payment is received on time, the credential/license holder is eligible to practice while the credential/license is being processed. CLIA (Clinical Laboratory Improvement Act)ĬLIA (Clinical Laboratory Improvement Act).