20-595 Get Paid Faster: Follow Memorandum of Agreement Guidelines for American Indian Health Service Medi-Cal Claims

Date: 07/28/20

A new denial code appears for incorrect billing

California Health & Wellness Plan (CHWP) may deny American Indian Health Service (IHS) Medi-Cal claims that do not follow Indian Health Service – Memorandum of Agreement (IHS-MOA) guidelines.

New denial code                                            

Claims that do not follow the IHS-MOA may be denied with the following code:

EXz3: DENY: INCORRECT BILLING OF REVENUE CODE WITH HCPCS CODE

Bill corrected claims on or after August 1, 2020

Starting August 1, 2020, providers can submit a corrected claim for claims that have been denied with the above denial code. CHWP will work to remediate those corrected claims.

Follow IHS-MOA billing standards

To avoid payment delays, refer to the IHS-MOA for billing guidance.

As a reminder, revenue codes and CPT/HCPCS codes must be taken from the IHS-MOA Code Conversion Table (PDF) found on the California Department of Health Care Services website.

Learn more about billing IHS claims

For more information about billing IHS Medi-Cal claims, refer to provider update
20-318, Updated Guidance: To Avoid Claims Delays, Use the Correct Form to Bill Ancillary Services for American Indian Health Service Medi-Cal Claims. Provider update 20-318 is viewable on CHWP’s provider portal online under Provider News.

Additional information

Providers are encouraged to access CHWP’s provider portal online on the California Health & Wellness website for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries and more.

If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.