Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Medi-Cal Logo

CHDP Phase 2: Transition Billing Tips

September 13, 2017

Since the implementation of the Child Health and Disability Prevention (CHDP) Phase 2 code conversion and claim form transition, claims have been monitored to identify the most frequent claim denials. The list below cites the most frequent Remittance Advice Details (RAD) claim denials. The tips below are intended to help providers minimize future claim denials. Additionally, providers must resubmit the denied claims in accordance with timeliness requirements by submitting a Claims Inquiry Form (CIF) or an Appeal Form (90-1). For CIF and Appeal Form (90-1) completion instructions, providers may refer to the CIF Completion or Appeal Form Completion sections in the appropriate Part 2 Manual.

RAD Message 0037 – Health Care Plan enrollee, capitated service not billable to Medi-Cal.
Verify if the recipient is enrolled in a Managed Care Plan. If so, the service is not billable to Medi-Cal.

RAD Message 0049 – Provider billing error. Claim line is invalid. Verify line charge, procedure code and other line information.
Claim lines that are filled with a zero (“0”) will result in an invalid claim line error message. Providers should verify their software or their submitter's software is not set to zero fill blank lines, which will cause unnecessary denial notices.

RAD Message 0145 – This procedure is not a Medi-Cal benefit on this date of service.
Verify that the procedure code being billed is valid for the date of service (or from-through dates of service) being billed. Also verify authorization information.

RAD Message 9641 – The procedure code billed requires modifier SL.
Verify the specific requirements for the immunizations you are billing. Many immunizations require a modifier. For more information please visit the Medi-Cal website.

RAD Message 9888 – The recipient's aid code is not allowed for this provider type.
Federally Qualified Health Centers, Rural Health Clinics and Indian Health Services – Memorandum of Agreement 638, Clinics should verify they are billing with the appropriate local codes for their provider type and services rendered. This allows claims to process through the system correctly.

For help in completing the CMS-1500 claim form, providers may refer to the Part 2 provider manual section, CMS-1500: Completion. In addition, the Medi-Cal Learning Portal website offers a class on claim form completion.