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Non-Every Woman Counts Claims Erroneously Denied with RAD Code 0033

October 6, 2017

The Department of Health Care Services (DHCS) identified a claims processing issue causing claims billed with HCPCS infusion codes (J7030, J7040, J7050, and J7120) to erroneously deny with Remittance Advice Details (RAD) Code 0033: The recipient is not eligible for the special program billed and/or restricted services billed.

DHCS and the Medi-Cal Fiscal Intermediary are working to resolve this issue. Affected claims may be reprocessed via a future Erroneous Payment Correction; therefore, providers should continue to bill their claims timely and check for updates on the Medi-Cal website.

For Physician-Administered Drugs billing instructions, please refer to the appropriate Part 2 Provider Manual sections.