Processing Delays for Podiatry Claims

February 7, 2020

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting providers billing podiatry services. The system changes for podiatry services have been successfully implemented for Optional Benefits Exclusion (OBE); however, other system changes related to the provisions of Assembly Bill 678, (Flora, Chapter 433, Statutes of 2019) are still under development. Providers may experience erroneous denials for claims billed without a Treatment Authorization Request.

No action is required of providers. DHCS and the California MMIS Fiscal Intermediary are working to resolve this issue. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.