Billing Tips: Family PACT (Planning, Access, Care and Treatment)
Remittance Advice Details (RAD) Claim Denials
RAD codes 0105 and 0115: This service requires a valid Family PACT Sterilization Consent Form. The Sterilization Consent Form is incomplete. A letter is being sent that indicates needed correction(s).
- Verify the correct consent form is being used.
- Effective February 1, 2006, Family PACT requires the use of the Sterilization Consent Form (PM 330).
- Refer to the Sterilization section of the Part 2 provider manual and the Benefits: Primary Contraceptive Services section of the Family PACT Policies, Procedures and Billing Instructions manual.
RAD code 0117: This procedure is payable only twice per month.
- Ongoing education and counseling codes (any combination of HCPCS codes Z9752-Z9754) can only be billed twice in 30 days, per recipient, per provider.
- Medical record documentation must reflect scope of services provided.
RAD code 9516: Secondary diagnosis code is missing or invalid for procedure code.
- Verify that the secondary diagnosis code is valid for the procedure code being billed.
- Review the Clinical Services Benefits Grid in the Family PACT provider manual.
- Call the Telephone Service Center (TSC) for assistance at 1-800-541-5555.
RAD code 9518: The Referring provider must be a Family PACT certified provider.
- Verify that the referring provider is enrolled as a Family PACT provider.
RAD code 9887: The service being billed is not payable when billed with an infertility diagnosis.
- Please refer to the Family PACT Program Overview section in the Family PACT Policies, Procedures and Billing Instructions Manual for assistance.
- Call the TSC for assistance at 1-800-541-5555.
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