Denial: Medi-cal/ CCS coverage

This article explains the process of disputing a member coverage issue by submitting a corrected claim. It guides you through the necessary steps to address any discrepancies with the coverage, including how to prepare and file the corrected claim effectively. The goal is to ensure that the coverage is accurately reflected and any errors are resolved.


When verify patients Medi-cal will generate a Trace Number/Eligibility Verification Confirmation Number aka "EVC". We can attached that to a corrected claim as proof of eligibility on the date of service.

The information must be listed in the "Other ID" field (Box 19) on the form. This field is used to identify the specific eligibility check performed for the patient and can be beneficial for claims processing and verification purposes.

Adding comments to BOX 19

  1. Find the first line number ( Note: you only need to add it the first line number)
  2. Right Click > Click on "EDIT"
  3. Common tab> System Comment
  4. Type in desired Comment in this case type in "EVC# 9019V7MM9". Click "Accept"
  5. Demand Claim. Comment should generate on claim as your proof of eligibility attached to the claim.

Resources

12/18/2024