Erroneous Denial of Pathology Claims

A claims processing issue has caused many pathology codes to deny when billed without a modifier. This issue is affecting claims submitted for dates of service on or after October 1, 2015. These claims are receiving a Resubmission Turnaround Document (RTD) and are being denied with Remittance Advice Details (RAD) code 196: This procedure requires a modifier; modifier is not present. Impacted providers do not need to take any action. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC). Providers should continue to submit claims in a timely manner.