Resubmission of Erroneously Denied Pathology Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting some claims billed with CPT pathology codes. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) codes 0196: This procedure requires a modifier; modifier is not present or 0036: RTD (Resubmission Turnaround Document) was either not returned or was returned uncorrected; therefore, your claim is formally denied. This issue affected claims for dates of service from October 1, 2015, through April 11, 2016. No action is required on your part. Xerox State Healthcare, LLC (Xerox) will resubmit the affected claims. These resubmissions will appear on RAD forms beginning September 22, 2016, with Claim Control Number (CCN) roll number 55 (Resubmit). The roll number is the fifth and sixth digits of the CCN.