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RAD Code 0558 Turned Off for LTC and Inpatient Claims

July 14, 2017

Current claim submission standards for long term care (LTC) and inpatient claim types do not fully support Patient Protection and Affordable Care Act ordering, referring and prescribing (ORP) provider requirements. Medi-Cal will defer implementation and enforcement of ORP requirements for LTC and inpatient claim types until a fully supported solution is designed.

Until further notice, Remittance Advice Details (RAD) for these claim types will not use RAD code 0558: Ordering/Referring/Prescribing NPI not enrolled or eligible for the service billed on date of service. Future claims may deny.

Providers should watch for updates on implementation and enforcement of ORP requirements in Medi-Cal Update bulletins and the Ordering, Referring and Prescribing (ORP) page on the Medi-Cal website.