Adjustment of Laboratory Services Claims Due to Retroactive Rate Updates

The Department of Health Care Services (DHCS) is implementing an additional phase of the Erroneous Payment Correction (EPC) related to reference number P33416. The upcoming phase, P33416G, adjust provider reimbursement rates for clinical laboratory services, effective retroactively for dates of service on or after July 1, 2015. The clinical laboratory rates were updated in accordance with California Assembly Bill 1494 (Chapter 28, Statutes of 2012) and the approved State Plan Amendment 15-015. The prior phase, P33416F, was implemented on January 22, 2019.

No action is required of providers. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will adjust the affected claims. These adjustments will appear on Remittance Advice Details (RAD) forms beginning approximately February 13, 2020, with RAD code 0893: Retroactive rate adjustment.