Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Medi-Cal Logo
Click to Sign Up for MCSS emails

Claims for Noncapitated Antivirals for HCP 915 Erroneously Denied

February 27, 2019

From January 1, 2019, through January 15, 2019, claims for noncapitated antiviral drugs for recipients enrolled in AIDS Healthcare Foundation's Managed Care Plan (MCP) in Los Angeles County (HCP 915) for dates of services on or after January 1, 2019, erroneously denied with Remittance Advice Details (RAD) code 0037: Health Care Plan enrollee, capitated service not billable to Medi-Cal.

Treatment Authorization Requests (TARs) for these services submitted to Medi-Cal from January 1, 2019, through January 15, 2019, may also have erroneously denied. Providers should resubmit denied TARs.

The claims processing issue has been resolved. An Erroneous Payment Correction (EPC) will be implemented to reprocess erroneously denied claims.