A problem was identified that may cause claims to deny erroneously with Remittance Advice Details (RAD) code 094:

The rendering provider is not eligible for this group type. Please resubmit claims using individual provider numbers or under appropriate group types.

This denial affects claims submitted with a National Provider Identifier (NPI) registered to multiple provider groups that provide different types of services. The Department of Health Care Services (DHCS) is working to correct the problem; however, no timeframe for the resolution has been established. DHCS is reviewing the possibility of notifying affected providers by bulletin or letter.

Although a problem has been identified that results with the above RAD code, the denial reason may be valid for some providers. Medi-Cal recommends that providers who receive these denials maintain timeliness of their claims to avoid reductions in the reimbursement amount. For guidelines and time frames for submitting Claims Inquiry Form (CIF) providers may refer to the CIF Submission and Timeliness Instructions section in the appropriate Part 2 manual.