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Claims Processing Issue with Submitting Pathology Codes

April 27, 2016

The Department of Health Care Services (DHCS) is aware of a claims processing issue affecting the following pathology codes billed without an attachment.

The issue affects claims submitted for dates of service on or after October 1, 2015. These claims are receiving Remittance Advice Details (RAD) code 188: This is a “By Report” procedure. No report is attached or the attached report is insufficient to warrant payment.

Impacted providers should continue to resubmit or appeal denied claims with appropriate delay reason codes and documentation. Information for how to resubmit claims is available in the UB-04 Submission and Timeliness Instructions or CMS-1500 Submission and Timeliness Instructions sections of the Part 2 provider manual. Providers may appeal the claim. Instructions for completing an Appeal Form (90-1) are in the Appeal Form Completion section of the Part 2 provider manual.

Providers are encouraged to check the Medi-Cal website regularly for updates regarding this issue.

G0472 80300 80301 80302 80303 80304 80320 80321
80322 80323 80324 80325 80326 80327 80328 80329
80330 80331 80332 80333 80334 80335 80336 80337
80338 80339 80340 80341 80342 80343 80344 80345
80346 80347 80348 80349 80350 80351 80352 80353
80354 80355 80356 80357 80358 80359 80360 80361
80362 80363 80364 80365 80366 80367 80368 80369
80370 80371 80372 80373 80374 80375 80376 80377
81288 81420 81435 81436