Medi-Cal Clinical Laboratory Claims Adjustments

Assembly Bill 133 (Committee on Budget, Chapter 143, Statutes of 2021) required the Department of Health Care Services (DHCS) to not retroactively implement rate reductions for clinical laboratory or laboratory services for dates of service January 1, 2020 thru June 30, 2021. DHCS will implement new Erroneous Payment Corrections (EPCs) to undo retroactive recoupments that have been implemented due to overpayments for clinical laboratory or laboratory services for dates of service January 1, 2020, through June 30, 2021.

Affected providers will receive new EPCs to undo retroactive recoupments that were processed because of rate adjustments that were applied retroactively between the effective date of the State Plan Amendment (SPA) and rate adjustment implementation date as follows:

• SPA 20-0003 Rate Adjustments, effective January 1, 2020
  • Rate Adjustment Implemented February 22, 2021
  • Undo Retroactive Recoupment, effective January 1, 2020, thru February 21, 2021
• SPA 20-0010 Rate Adjustments, effective July 1, 2020
  • Rate Adjustment Implemented April 26, 2021
  • Undo Retroactive Recoupment, effective July 1, 2020, thru April 25, 2021

Source: https://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/gm202207.aspx