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!