Medi-Cal identifies and fixes system issue

November 09, 2015
Area(s) of Interest: Fraud & Abuse Licensing & Regulatory Issues Payor Issues and Reimbursement 

In July, Medi-Cal announced it had identified a system issue that caused resubmission turnaround documents (RTDs) to be issued on some CPT codes in error. The problem began on June 22, when some claims billed with CPT codes 88141, 92002, 92004, 92012, 92014, 92015, 93000, 93005 and 93010 generated RTDs with remittance advice detail (RAD) code 0196: This procedure requires a modifier; modifier is not present. 

On September 24, Medi-Cal published a follow-up bulletin to advise the error was fixed July 31, 2015, and that claims processed on or after August 1 were processed correctly, with no action required by affected physicians. Xerox began automatically reprocessing claims that had previously generated an RTD in error on August 19, 2015. It is also reprocessing any claims where providers responded to the RTD and received a denial through its erroneous payment correction process.

The California Medical Association has inquired with the Department of Health Care Services about the volume of claims affected as well as timing of when the claims processing project will be completed.


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