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Clarification Regarding Adjustments for Radiology Services Rate Updates

May 12, 2016

The Department of Health Care Services (DHCS) provides the following message to alleviate confusion regarding claim adjustments via the Retroactive Claims Adjustment for Radiology Services Rate Updates Erroneous Payment Correction (EPC) P29678:

Affected providers will see claim adjustments identified by Remittance Advice Details (RAD) code 0966: Retroactive rate adjustment beginning April 25, 2016. Providers may receive a separate, additional RAD for these adjustments, resulting in some providers receiving more than one RAD in a week. Payment recoveries for these claim adjustments begin May 2, 2016. These adjustments are installed in phases; therefore, some providers will see their adjustments on future checkwrites.

To help alleviate the financial impact of these recoveries, DHCS will allow affected providers to repay the account receivables (A/R) for EPC P29678 over a period of time.

Note:

A provider’s RADs may also be affected by other adjustments or A/Rs unrelated to EPC P29678. All other recoveries will continue to recoup at 100 percent (i.e. cost settlements, provider initiated adjustments by Claims Inquiry Form [CIF] or appeals, etc.).