Hold Vaccine Claims or Submit Them Now? Get a Better Perspective

If your insurer has not said a peep about whether it'll accept the new vaccine administration codes 90460-90461; you should contact the provider relations department directly. That is how Bonnie Palmer with Lawrenceville Pediatrics in Georgia determined which claims she should submit now, and which she should hold onto.

Her local insurers provided her the following advice on submitting claims. If you like to follow her lead and determine which payers are reimbursing for vaccines, get in touch with all of the payers with whom you are contracted and ask them for specific advice on the new codes. That apart, she adds, “I'd recommend that offices only send a few claims to see how they are processing before they send hundreds and find out what they're all denying.

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Blue Cross and Blue Shield of Georgia has the new codes loaded into its systems for all claims with dates of service (DOS) on or after January 1 this year – but then the insurer initially asked practices not to submit these claims until February 3 this year. If you billed the just-in codes prior to February 3, the system denied the second or third unit of 90460 or 90461 as a duplicate and you'll have to call the claims department and have the claim reprocessed for proper payment.

The claims systems for Aetna, Humana, Guardian, Taylor Benefit Systems, and Coventry Health Care are all geared to accept the vaccine claims for all DOS on or after January 1, 2011.

The United Health Care Web site indicates that practices shouldn't use the just-in codes until April 1; however Palmer was told by a UHC rep that this information wasn't posted to the website the correct way. The UHC rep advised her that the insurer's system is actually capable of handling the new codes now for all DOS on or after January 1 this year. If you did bill your vaccine services with the old codes based on the wrong information on the UHC website, you will have to rebill all of those claims with the new administration fees and write 'corrected claim' at the top of your claim form.