Retro Payment Adjustments Announced by Medi-Cal

January 14, 2021

On December 3rd, the Department of Health Care Service (DHCS) CA Medi-Cal updated its provider reimbursement rates for select clinical laboratory services. These changes will have an effective retroactive date of service on or after April 1, 2019. According to California Medicaid Management Information Services (MMIS), there is no action required as they will adjust the affected claims. These adjustments will appear on Remittance Advice Details (RAD) forms starting December 24, 2020, with a RAD code 0893 (Retroactive Rate Adjustment).

These adjustments are authorized under the provision of Welfare and Institution Code (W&I Code) Sections 14176 and 14177, and California Code of Regulations (CCR), Title 22, Section 51458.1. Under the W&I Code sections, it authorizes DHCS to implement repayment agreements with providers or offset any overpayments against all amounts due.

A copy of the announcement letter can be found by clicking here.

For additional reference, please visit the Department of Health Care Services (DHCS) CA Medi-Cal website here and Select Article 13.

APS will continue to monitor and provide any updates as it becomes available.