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Payment Processing Error for Procedure Codes

January 30, 2019

The Department of Healthcare Services (DHCS) has identified an error which may have resulted in incorrect payments for certain surgery, radiology and medicine procedure codes. This issue affects claims for dates of service on or after January 1, 2019. An Erroneous Payment Correction (EPC) will be generated to reprocess claims.

No action is required of providers. DHCS and the California MMIS Fiscal Intermediary are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.