Medi-Cal – Resubmission of Erroneously Denied Claims for Laboratory/Pathology Codes

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims for all laboratory/pathology codes. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0169: This service is not payable when billed with this diagnosis and 9109: This service is not payable for the diagnosis billed. The issue affected claims for dates of service from April 1, 2022, through September 18, 2023. No action is required on your part. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will resubmit the affected claims. These resubmissions will appear on RAD forms beginning January 18, 2024, with Claim Control Number (CCN) roll number 55 (Resubmit). The roll number is the fifth and sixth digits of the CCN prefix 401055.