Reprocessing of Erroneously Paid and Denied Clinical Laboratory Claims- Drug Testing codes

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting claims billed with the following clinical laboratory CPT codes 80300-80369. This issue caused some claims to erroneously pay and some claims to erroneously deny with Remittance Advice Details (RAD) code 0188: This is a “By Report” procedure. No report is attached or the attached report is insufficient to warrant payment, or 0225: This is an incorrect procedure code and/or modifier for this service. Please resubmit. The issue affected claims for dates of service from October 1, 2015, through September 27, 2016. No action is required on your part. Conduent will adjust erroneously paid claims and resubmit erroneously denied claims. Adjustments will appear on RAD forms beginning August 3, 2017, with RAD code 0893: Retroactive rate adjustment. Resubmissions appeared on RAD forms beginning July 7, 2017, with Claim Control Number (CCN) prefix 718055.

INDUSTRY NEWS TAGS: California Medi Cal

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