Hold vaccine claims or submit them now?

You should contact the provider relations department directly if your insurer has not said a peep about whether it'll accept the new vaccine administration codes 90460-90461.

If you want to find out which payers are reimbursing for vaccines, get in touch with all of the payers with whom you're contracted and enquire them for specific advice on the just-in codes. What's more, it is recommended that offices only send a few claims to see how they are processing before they send hundreds and find out that they're all denying.

Blue Cross and Blue Shield of Georgia has the just-in codes loaded into its systems for all claims with dates of service on or after January 1 this year. However the insurer had initially asked practices not to submit claims until February 3. If you had billed the just-in codes before February 3, the system would have denied the second or third unit of 90460 or 90461 as a duplicate and you would have had to call the claims department and have the claim reprocessed for correct payment.

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

The United Health Care website indicates that practices should not use the just-in codes until April 1; however a UHC rep said that this information was posted to the Website mistakenly. According to the UHC website, you will have to rebill all of those claims with the just-in administration fees and write ‘corrected claim' at the top of your claim form.

Source URL :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/practice-perspective-get-to-know-whether-to-hold-vaccine-claims-or-submit-them-now-article