Medi-Cal REPROCESSING OF ERRONEOUSLY PAID AND DENIED CLAIMS FOR SELECT ICD-10 DIAGNOSIS CODES

The Department of Health Care Services (DHCS) updated the effective through date for select International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes. This issue caused claims for the Date of Service on or after October 1, 2020, to erroneously pay. This issue also caused claims for Date of Service October 1, 2015, through September 30, 2020, to erroneously deny with Remittance Advice Details (RAD) code 0691: Diagnosis Code Is Invalid For Date Of Service.

No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will void and resubmit erroneously paid claims and resubmit erroneously denied claims. These voids will appear on RAD forms beginning September 8, 2022, with RAD code 0819: Void and resubmit of claims processed in error. Corresponding resubmissions will appear on RAD forms beginning September 15, 2022. Resubmissions of denied claims will appear on RAD forms beginning August 4, 2022, with Claim Control Number (CCN) prefix 220655.

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2022/31838_p43855.pdf