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    • August 29, 2017

    The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed with ICD-10-CM diagnosis code Z33.2 (encounter for elective termination of pregnancy). This issue caused some claims to erroneously pay and some claims to erroneously deny. The issue affected claims for dates of service from October 1... more

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    • August 29, 2017

    The Department of Health Care Services (DHCS) has identified a claims processing issue affecting claims billed with the following CPT clinical laboratory codes 80321-80377. This issue caused some claims to erroneously pay and some claims to erroneously deny. The issue affected claims for dates of service from October 1, 2015, through December 28,... more

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    • August 29, 2017

    The Department of Health Care Services (DHCS) has updated the rates for clinical laboratory services, effective retroactively for dates of service on or after July 1, 2016. No action is required on your part. Conduent will adjust affected claims. These adjustments will appear on Remittance Advice Details (RAD) forms beginning September 21, 2017,... more

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    • August 29, 2017

    The Department of Health Care Services (DHCS) recently revised its allergy testing policy in response to stakeholder feedback and review of scientific literature. The revised blood allergy policy is based on a thorough review of various condition-specific clinical guidelines and feedback from the stakeholder communities, clinical professors and... more

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    • August 29, 2017

    A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs... more

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    • July 28, 2017

    Effective for dates of service on or after August 1, 2017, modifier KX (requirements specified in the medical policy have been met) may be used to facilitate claim processing in instances where the patient's gender conflicts with the billed procedure code. The patient's medical record must support medical necessity for the procedure. Providers may... more

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    • July 28, 2017

    Effective for dates of service on or after August 1, 2017, CPT Code 75561 (cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences) is listed as a Medi-Cal benefit.

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    • July 28, 2017

    The Department of Health Care Services (DHCS) identified a claims processing issue affecting some laboratory services claims billed with CPT code 80061 (lipid panel). This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0169: This service is not payable when billed with this diagnosis or 9109: This service is not... more

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