Medi-Cal DMC Billing Rule Correction 

Two procedures — Residential Treatment Substance Abuse and Residential Withdrawal Management — were inadvertently included last week in the Medi-Cal DMC billing rule, “These codes are not billable to this plan.” As a result, some charges may have incorrectly cascaded from Medi-Cal responsibility. 

The procedures have since been removed. However, SmartCare applied adjustment code CO-45 instead of the configured reallocation adjustment code, preventing balances from automatically transferring back to Medi-Cal. A ticket has been submitted to address this issue. 

Action required: Charges that did not automatically reallocate back to Medi-Cal must be corrected. CalMHSA recommends delaying posting of DMC Medi-Cal 835 files until balances are correctly reflected under Medi-Cal. 

• If Medi-Cal is not the primary payer, manually transfer the remaining balance back to Medi-Cal.  

• If Medi-Cal is the primary payer, use charge regeneration to move the balance back.  

• • This action will leave previously billed charges in a “Billed” status, with all batch information, including the billed date, remaining in place.  

• • If a payment was applied and the balance is zero, the payment information will remain along with the zero balance. 

Before regenerating charges, ensure the configuration key “RegenerateChargesForBilledServices” is set to Yes. After regeneration, charges will appear as “Not Ready to Bill” and will be updated to “Ready to Bill” during the billing process.  

For questions, please contact Khristy Pease ([email protected]) or Lisa Kirlin ([email protected]).