EPC – REPROCESSING OF CLAIMS FOR SELECT COVID-19-RELATED CPT CODES – P43684

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims billed with COVID-19 related laboratory codes. This issue caused claims to erroneously pay with a quantity cutback code of 435 (Quantity billed for procedure exceeds usual practice). The issue affected claims for dates of service from July 1, 2020 through, March 21, 2022.

No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will void and resubmit the affected claims. These voids will appear on Remittance Advice Details (RAD) forms beginning July 21, 2022, with RAD code 0819: Void and resubmit of claims processed in error. Corresponding resubmissions will appear on RAD forms beginning July 28, 2022, with Claim Control Number (CCN) roll number 55 (Resubmit). The roll number is the fifth and sixth digits of the CCN.

Tags: Medi-Cal

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2022/31132_75_p43684.pdf