Resubmission of Erroneously Denied Medicare/Medi-Cal Crossover Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims for medical services, including Medicare/Medi-Cal crossover claims. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0031: The provider was not eligible for the services billed on the date of service. The issue affected claims for dates of service from December 28, 2015, through February 9, 2017. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning October 5, 2017, with Claim Control Number (CCN) prefixes 726788 and 727055.