Remittance Advice Details (RAD) Claim Denials

RAD codes 0105 and 0115: This service requires a valid Family PACT Sterilization Consent Form. The Sterilization Consent Form is incomplete. A letter is being sent that indicates needed correction(s).

• Verify the correct consent form is being used.
• Effective February 1, 2006, Family PACT requires the use of the Sterilization Consent Form (PM 330).
• Refer to the Sterilization section of the Part 2 provider manual and the Benefits: Primary Contraceptive Services section of the Family PACT Policies, Procedures and Billing Instructions manual.

RAD code 0117: This procedure is payable only twice per month.

• Ongoing education and counseling codes (any combination of HCPCS codes Z9752-Z9754) can only be billed twice in 30 days, per recipient, per provider.
• Medical record documentation must reflect scope of services provided.

RAD code 9516: Secondary diagnosis code is missing or invalid for procedure code.

• Verify that the secondary diagnosis code is valid for the procedure code being billed.
• Review the Clinical Services Benefits Grid in the Family PACT provider manual.
• Call the Telephone Service Center (TSC) for assistance at 1-800-541-5555.

RAD code 9518: The Referring provider must be a Family PACT certified provider.

• Verify that the referring provider is enrolled as a Family PACT provider.

RAD code 9887: The service being billed is not payable when billed with an infertility diagnosis.

• Please refer to the Family PACT Program Overview section in the Family PACT Policies, Procedures and Billing Instructions Manual for assistance.
• Call the TSC for assistance at 1-800-541-5555.

Note:

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.