RHC’s, FQHC’s and other clinic-based providers should be aware of the following regulatory updates.
Medi-Cal Code 19 Rate Settlements
Xerox mailed a letter dated March 26, 2014 stating that they will be reprocessing Code 19 (CHIP) claims that were previously denied in error. The effective dates of service were between 10/1/2009 through 6/30/2012. Both claims paid in error and denied in error will be reprocessed. Look for RAD code 0819 (start April 10th) voiding out old claims, CCN prefix 407955 (start April 3rd) for payments on erroneously denied claims, and CCN prefix 410055 (start April 24th) for erroneously paid claims on your RAs. Be aware that Xerox is reducing payments for these old claims if a valid billing limit exception was not submitted. These newly paid claims are eligible for reconciliation to the PPS rate. If you have received a final audit report for the Code 19 Retroactive Reconciliation, review it to determine if the visits and/or payments for these reprocessed claims were included. If they were not, and the number is significant, consider filing an appeal to request reconciliation of the newly adjudicated claims. (more…)