Resubmission of Erroneously Paid and Denied Claims for HPV CPT Codes

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed with Human Papillomavirus (HPV) CPT codes 87623, 87624 and 87625. This issue caused some claims to erroneously pay; other claims were erroneously denied with Remittance Advice Details (RAD) codes 033: The recipient is not eligible for the special program billed and/or restricted services billed or 063: The procedure is not consistent with the recipient’s age. This issue affected claims for dates of service from October 1, 2015, through February 23, 2016. No action is required on your part. Conduent will void and resubmit the affected claims. Voids of paid claims will appear on RAD forms beginning March 2, 2017, with RAD code 0819: Void and resubmit of claims processed in error. Corresponding resubmissions of paid claims will appear on RAD forms beginning March 9, 2017. Resubmissions of denied claims appeared on RAD forms beginning February 9, 2017.

SOURCE: Source
INDUSTRY NEWS TAGS: California Medi Cal

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