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System Issue Related to RAD Code 0196 Resolved

October 9, 2018

On July 23, 2018, a claims processing issue impacting claims billed with non-split-billable codes is resolved. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0196: This procedure requires a modifier; modifier is not present. Claims submitted for dates of service on or after July 23, 2018, are now processing correctly.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims for specific non-split-billable codes with dates of service on or after October 1, 2015, through July 23, 2018, erroneously denied with RAD code 0196.