Resubmission of Erroneously Denied Claims for Services Authorized by CCS

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed for services authorized by California Children's Services (CCS). This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0037: Health Care Plan enrollee, capitated service not billable to Medi-Cal. The issue affected claims for dates of service from December 29, 2014, through October 24, 2016. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning May 18, 2017, with Claim Control Number (CCN) roll number 55 (Resubmit).

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INDUSTRY NEWS TAGS: California Medi Cal

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