Resubmission of Erroneously Denied Laboratory Services Claims

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting some laboratory services claims. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 9655: The monthly frequency limits for this procedure have been exceeded. Please appeal with justification for exceeding the frequency limits, or 0102: This service requires an original Medi label or a Medi-Service reservation. The issue affected claims for dates of service from August 1, 2015, through July 26, 2016. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning June 22, 2017, with Claim Control Number (CCN) prefix 716555.

INDUSTRY NEWS TAGS: California Medi Cal

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