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Claims Processing Issue for FQHC/RHC/IHS-MOA Providers

January 3, 2018

A claim processing issue was identified, causing claims to erroneously deny with Remittance Advice Details (RAD) code 033: The recipient is not eligible for the special program billed and/or restricted services billed. This issue impacts Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services-Memorandum of Agreement (IHS-MOAs) 638, Clinics, for claims adjudicated between September 25, 2017 and October 25, 2017. Claims erroneously denied with this RAD message will be reprocessed.