How do I follow up on a claim denied with Remittance Advice Details (RAD) code 002: The recipient is not eligible for benefits under the Medi-Cal program or other special programs?
When following up on RAD code 002, use a Point of Service (POS) device to verify a recipient’s eligibility. If a recipient is eligible, submit an Appeal Form to EDS, an HP company with the Eligibility Verification Confirmation (EVC). If timeliness requirements can be met, rebill the claim. For more information on appeals, Long Term Care, Pharmacy and Vision Care providers should refer to provider manual Section 400-61. Allied Health, Inpatient, Outpatient and Medical Services providers should refer to Appeal Process Overview in the Part 1 manual. Note: To acquire a POS Device, call the POS Help Desk at 1-800-427-1295.
Related Questions
- How do I follow up on a claim denied with Remittance Advice Details (RAD) code 002: The recipient is not eligible for benefits under the Medi-Cal program or other special programs?
- Is the Claim Control Number (CCN) the number on the Remittance Advice Details (RAD)? Are we supposed to obtain the CCN from the Internet before checking a claims status?
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