Billing Tips: Managed Care Plans

Remittance Advice Details (RAD) Claim Denials

RAD code 0037: Health Care Plan enrollee, capitated service not billable to Medi-Cal.

• Verify Recipient’s 14-character ID number with a valid BIC prior to rendering service, except in an emergency.
• Verify the recipient's ID number on the RAD.
• Determine the Health Care Plan (HCP) to be billed and bill the appropriate HCP.