Adjustment of Laboratory Claims for 10 Percent Provider Payment Reductions

July 8, 2020

The Department of Health Care Services (DHCS) is implementing a phase of Erroneous Payment Correction (EPC) number P33376. This upcoming phase, P33376G, adjusts provider reimbursement rates for clinical laboratory services, effective retroactively for dates of service on or after July 1, 2012. Effective retroactively for date of service from July 1, 2012, through June 30, 2015, Assembly Bill 1494 (Chapter 28, Statutes of 2012) authorizes DHCS to reduce Med-Cal provider payments by 10 percent. The prior phase, P33376F, was implemented on January 25, 2019.

No action is required of providers. The California Medicaid Management Information System (MMIS) Fiscal Intermediary will adjust the effected claims for various clinical laboratories and laboratory service codes. These adjustments will appear on Remittance Advice Detail (RAD) forms beginning July 2, 2020, (for positive adjustments), and July 30, 2020, (for negative adjustments), with RAD code 0981: State Initiated claim adjustment.

An EPC letter has been issued to address this claim adjustment.