Resubmission of Erroneously Denied Claims for Split-Bill Procedure Codes

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims billed with split-billable procedure codes. This issue caused some claims to erroneously deny with Remittance Advice Details (RAD) code 0196: This procedure requires a modifier; modifier is not present. The issue affected claims for dates of service from August 1, 2015, through September 1, 2017. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning October 26, 2017, with Claim Control Number (CCN) prefix 728955.