Medi-Cal Claims: A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission

Monday, Aug. 2nd 2010 6:03 AM

A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs between hospitals and nursing homes during the transfer of the recipient. Providers see this on their Remittance Advice Details (RADs) as a claim denied by RAD code 010.

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Posted on Monday, Aug. 2nd 2010 6:03 AM | by Share of Cost | in Medi-Cal | No Comments »