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

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting claims billed with the following CPT clinical laboratory codes 80321-80377. This issue caused some claims to erroneously pay and some claims to erroneously deny. The issue affected claims for dates of service from October 1, 2015, through December 28, 2016. No action is required on your part. Conduent will adjust erroneously paid claims and resubmit erroneously denied claims. Adjustments will appear on Remittance Advice Details (RAD) forms beginning August 31, 2017, with RAD code 0893: Retroactive rate adjustment. Resubmissions of denied claims will appear on RAD forms beginning August 10, 2017, with Claim Control Number (CCN) prefix 721555.

INDUSTRY NEWS TAGS: California Medi Cal

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