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Application for Certificate of Clearance for Medical Assistance Claim Minncle Form

Application for Certificate of Clearance for Medical Assistance Claim Minncle Form

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welcome this is lighthouse lab services my name is John Harrell I'm the president of lighthouse cloud services and I have Tara Llewellyn our manager of our laboratory director program here with me and today we're going to go through how to fill out a CLIA application a CMS 1/16 form we're going to focus today on filling this out as a new application so if you're starting a new medical laboratory that's going to be doing diagnostic testing you will need a CLIA certificate and we're going to walk through how to fill that out this form is also used beyond being an initial application for changes to your tests menu or certificate type or change to your lab director would also be using this form so on section 1 we are going to focus on what is required when you submit your application you're going to need to put in your facility name you're going to need to put in an email address and a tax ID number your federal tax ID number it's going to need to match the facility name that you use so t

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