Resubmission of Claims Billed for ICD-10-CM Codes N36.43, M96.1 and Q76.2

The Department of Health Care Services (DHCS) identified a claims processing issue with some claims for ICD-10-CM diagnosis codes N36.43, M96.1 and Q76.2. This issue caused some claims to erroneously pay and some claims to erroneously deny. This issue affected claims for dates of service from October 1, 2015, through July 25, 2016. No action is required on your part. Xerox State Healthcare, LLC (Xerox) will void and resubmit erroneously paid claims. Voids will appear on Remittance Advice Details (RAD) forms beginning January 26, 2017, with RAD code 0819: Void and resubmit of claims processed in error. Corresponding resubmissions will appear on RAD forms beginning February 2, 2017. Resubmissions of denied claims will appear on RAD forms beginning January 19, 2017, with Claim Control Number (CCN) roll number 55 (Resubmit). The roll number is the fifth and sixth digits of the CCN.

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INDUSTRY NEWS TAGS: Radiology News, California Medi Cal

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