Resubmission of Erroneously Denied Breast Cancer and Cervical Cancer Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed with the following CPT codes for breast cancer and cervical cancer; 76098, 76645, 76942, 77031, 77032, 77055 and 77056. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0095: This service is not payable due to a procedure, or procedure and modifier, previously reimbursed. The issue affected claims for dates of service from December 23, 2013, through June 27, 2016. No action is required on your part. Xerox State Healthcare, LLC (Xerox) resubmitted the affected claims. These resubmissions appeared on RAD forms beginning December 1, 2016, with Claim Control Number (CCN) roll number 55 (Resubmit).