Resubmission of Erroneously Denied Human Leukocyte Antigen Typing Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims for CPT code 81381 (Human Leukocyte Antigen Class I typing, high resolution; one allele or allele group, each) billed with ICD-9 diagnosis codes 042, V08 and 795.71. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 9109: This service is not payable for the diagnosis billed or 0169: This service is not payable when billed with this diagnosis. The issue affected claims for dates of service from October 01, 2012, through April 20, 2016. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning February 2, 2017, with Claim Control Number (CCN) roll number 55 (Resubmit).

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INDUSTRY NEWS TAGS: California Medi Cal

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