Resubmission of Erroneously Denied Split-Billable Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting split-billable claims with no modifier. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0095: This service is not payable due to a procedure, or procedure and modifier, previously reimbursed. The issue affected claims for dates of service from August 1, 2015, through February 17, 2016. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning June 15, 2017, with Claim Control Number (CCN) prefix 715655.

INDUSTRY NEWS TAGS: Radiology News, California Medi Cal

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