EPC Letter: Reprocessing of Erroneously Paid and Denied Medicare Crossover Claims

The Department of Health Care Services (DHCS) updated Medicare deductibles and coinsurance rates for outpatient, inpatient, and medical claims, effective retroactively for dates of service on or after January 1, 2019. Some claims processed before the rate update could have been erroneously paid or denied with Remittance Advice Details (RAD) code 0375: EOMB not attached. Bill Medicare. No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary, Conduent State Healthcare, LLC, will void and resubmit erroneously paid claims and resubmit erroneously denied claims. These voids will appear on RAD forms beginning July 25, 2019, with RAD code 0819: Void and resubmit of claims processed in error. Corresponding resubmissions will appear on RAD forms beginning August 1, 2019. Resubmissions of denied claims will appear on RAD forms beginning June 27, 2019, with Claim Control Number (CCN) prefixes 916955 and 916688.