Adjustment of Claims for Retroactive Rate Updates of Select Radiology Codes

EPC Letter P47528: The Department of Health Care Services (DHCS) updated provider reimbursement rates for select radiology codes, effective retroactively for dates of service on or after October 1, 2015. If the rate was increased, the adjustment is positive. If the rate was reduced, the adjustment is negative.

The California Medicaid Management Information System (MMIS) Fiscal Intermediary, Conduent State Healthcare, LLC, will adjust the affected claims. These adjustments will appear on Remittance Advice Details (RAD) forms beginning May 23, 2019 (for positive adjustments), and June 20, 2019 (for negative adjustments), with RAD code 0893: Retroactive rate adjustment.