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Updates to Processing Delays for Podiatry Claims

March 3, 2020

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting providers billing podiatry services. The system changes for podiatry services have been successfully implemented for Optional Benefits Exclusion (OBE); however, other system changes related to the provisions of Assembly Bill 678, (Flora, Chapter 433, Statutes of 2019) are still under development. Providers may experience erroneous denials for claims billed without a Treatment Authorization Request (TAR).

Previously DHCS stated providers should not submit claims until the issue has been resolved. However, due to the complexity of the issue, providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue. DHCS and the California MMIS Fiscal Intermediary (CA-MMIS FI) are working to resolve this issue. An Erroneous Payment Correction (EPC) will be implemented to reprocess the affected claims.