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Medical Transportation Claim Submission Updates

September 16, 2016

Medicare Non-Covered Services
The following medical transportation HCPCS procedure codes have been identified as Medicare non-covered services: A0130, A0225, A0380, A0390, A0420, A0422, A0424, T2001, T2005 and T2007. Claims submitted for these services from June 27, 2016, through July 20, 2016, were erroneously denied for failure to provide proof of Medicare denial prior to submission with Remittance Advice Details (RAD) code 0012: Medi-Cal benefits cannot be paid without proof of payment/description of the denial from Medicare. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC). No action is required of providers.

Other Health Coverage (OHC)
Effective retroactively for dates of service on or after April 1, 2015, medical transportation claims submitted for recipients with OHC code “F”, Medicare Part C Health Plan will no longer require a Medicare denial letter for the following HCPCS procedure codes: A0130, A0225, A0380, A0390, A0420, A0422, A0424, T2001, T2005 and T2007.

These claims were erroneously denied with RAD code 0640: Recipient is not eligible for Medi-Cal benefits without complete denial of coverage from the Medicare Health Maintenance Organization (HMO), Competitive Medical Plan (CMP) or Health Care Prepayment Plan (HCPP). Medi-Cal is not obligated for plan services when the recipient chooses not to go to a plan provider. Affected claims will be reprocessed via an EPC. No action is required of providers.

For additional information regarding OHC codes, refer to the Other Health Coverage (OHC) Guidelines for Billing section in the Part 1 provider manual.