Medi-Cal – Resubmission of Erroneously Denied Claims of Select Cpt Codes

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims billed with select Coronavirus Disease Vaccines related CPT® codes. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0037: Health Care Plan Enrollee or Mental Health Plan Recipient; Capitated/Covered Service Not Billable to Medi-Cal. The issue affected claims for dates of service from September 11, 2023, through December 26, 2023.

Source: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/D26EE7C0-13B6-42D6-AD22-6B19846A6B8E/32832_p44792.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO