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What are some common types of Drug Medi-Cal disallowances?

April 26, 2017common drug Medi-Cal types

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What are some common types of Drug Medi-Cal disallowances?

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Erroneous billings: This disallowance category is typically applied to those services billed for reimbursement which are not substantiated in the client file/records, services billed in error, services delivered off site, and services delivered at an uncertified location. Ineligible ODF (outpatient drug-free) individual counseling session: Individual counseling sessions for ODF are limited to intake, crisis, collateral services, and treatment and discharge planning. Individual counseling sessions billed to DMC other than these must be disallowed. Ineligible client served: The provision of DCH (day care habilitative) treatment services is limited to pregnant and postpartum beneficiaries or Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) beneficiaries. In addition, for Perinatal certified treatment programs, services are limited to pregnant and postpartum beneficiaries. UOS (unit of service) provided to DMC (Drug MediCal) clients served in these modalities and who do not m