Medi-Cal ADJUSTMENT OF LABORATORY SERVICES CLAIMS DUE TO RETROACTIVE RATE UPDATES

The Department of Health Care Services (DHCS) updated provider reimbursement rates for select Clinical Laboratory Services, effective retroactively for dates of service on or after July 1, 2020 through April 26, 2021. If the rate was increased, the adjustment is positive. If the rate was reduced, the adjustment is negative.

No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will adjust the affected claims. These adjustments will appear on Remittance Advice Details (RAD) forms beginning September 8, 2022 (for positive adjustments), and October 6, 2022 (for negative adjustments), with RAD code 0893: Retroactive rate adjustment.

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2022/31870_p43958.pdf