Resubmission of Erroneously Denied Outpatient and Medical Claims -modifier 91

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain outpatient and medical claims billed with modifier 91. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0225: This is an incorrect procedure code and/or modifier code for this service. Please resubmit or 0126: This rendering provider is not licensed to provide services with the billing provider on date of service. The issue affected claims for dates of service from October 03, 2011, through December 27, 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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