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Family PACT Claims Issue Resolved for RAD Codes 0169, 9515 and 9516

May 3, 2018

A NewsFlash article that published on February 23, 2018, titled “Family PACT Claims Erroneously Denied with RAD Codes 0169, 9515 and 9516,” notified providers that the Department of Health Care Services (DHCS) identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) claims to erroneously deny with Remittance Advice Details (RAD) codes 0169: This service is not payable when billed with this diagnosis, 9515: The procedure code is not a benefit of the Family PACT (Planning, Access, Care and Treatment) program and 9516: The secondary diagnosis code is missing or invalid for the procedure code.

The claims processing issue was resolved on March 2, 2018. An Erroneous Payment Correction (EPC) will be issued to reprocess affected claims retroactive to December 26, 2017. No action is required of providers. Providers should continue to submit claims in a timely manner.