Reprocessing of Erroneously Paid and Denied Claims Billed with Certain ICD-10-CM Codes

The Department of Health Care Services (DHCS) identified a claims processing issue with some claims billed with ICD-10-CM diagnosis codes O04.5, O04.6, O04.7, O04.8, O04.81, O04.82, O04.83, O04.84 and O04.89. This issue caused some claims to erroneously pay, while other claims were erroneously denied with Remittance Advice Details (RAD) codes 0169: This service is not payable when billed with this diagnosis, or 9109: This service is not payable for the diagnosis billed. The issue affected claims for dates of service from October 1, 2015, through November 16, 2016. No action is required on your part. Conduent will void and resubmit erroneously paid claims, and resubmit erroneously denied claims. Voids will appear on RAD forms beginning June 29, 2017, with RAD code 0819: Void and resubmit of claims processed in error. Corresponding resubmissions will appear on RAD forms beginning July 6, 2017. Resubmissions of denied claims will appear on RAD forms beginning June 2, 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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