Author Topic: MEDICAID Reimbursement / Vaccine Admin Reimbursement  (Read 4899 times)

ofcbilling

  • Newbie
  • *
  • Posts: 1
MEDICAID Reimbursement / Vaccine Admin Reimbursement
« on: February 01, 2013, 06:12:29 PM »
Hello!
We have this problem in Medicaid Reimbursement. Our facility is located in Northern Virginia and handles Amerigroup and Anthem Health Keepers Plus Medicaid.
For our 90460 and 90461 Vaccine Administration code, both insurance doesn't pay, however, both codes has price attached in the EOB.

Under the EOB each code has a denial code of PR-96.

PR code means Patient Responsibility.

But
PR-96 = 96 - Non-covered charge(s). At least one Remark Code must be provided (may
be comprised of either the NCPDP Reject Reason Code, or Remittance
Advice Remark Code that is not an ALERT.) Note: Refer to the 835
Healthcare Policy Identification Segment (loop 2110 Service Payment
Information REF), if present.

My question, what is that special "Remark Code" that we need to provide.

and I checked the Physician Fee Schedule Search - and it said that there's a payment for each code 90460 + 90461.
Moreover, we received a fax from Medicaid that they will increase the vaccine admin code from $12.00 -to  $21.00 this 2013.

How are we going to get reimbursement and what is/are the procedure/s that we need to do??

Thanks! More power!

LASHUNDA

  • Newbie
  • *
  • Posts: 6
Re: MEDICAID Reimbursement / Vaccine Admin Reimbursement
« Reply #1 on: April 11, 2013, 11:48:57 AM »
Normally Medicaid carriers use "G" codes for the administration charges.  Have you tried G0008 or G0009?  I'm in Texas.  We can bill Medicare with the 9xxxxx codes but not Medicaid.  You should probably check the Medicaid Provider manual and it will tell you.

shanbull

  • Full Member
  • ***
  • Posts: 176
Re: MEDICAID Reimbursement / Vaccine Admin Reimbursement
« Reply #2 on: June 13, 2013, 12:17:34 PM »
I have found these very helpful in explaining the differences in billing vaccines to Medicaid and Medicare:

http://www.kareo.com/gettingpaid/2012/05/immunizations-and-administration-coding-and-billing-them-correctly/

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf

The PDF brochure is mostly just for flu vaccines but it gives you an idea of the format to use. I'm sure they have more PDF's for other vaccine codes too.


Oh, and the "remark code" that must be provided means that the payer needs to provide it to clarify their denial. You don't need to provide anything. Basically, one of their codes will usually say something vague, so you then have to look up the other one which is more specific. Do you have these two lists? I just do ctrl+f and enter the code for denials:
http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/
http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/

Usually I can figure out what they're saying when I piece all the denial codes together without having to call them.
« Last Edit: June 13, 2013, 12:21:27 PM by shanbull »

Medical Billing Forum

Re: MEDICAID Reimbursement / Vaccine Admin Reimbursement
« Reply #2 on: June 13, 2013, 12:17:34 PM »