Is anyone out there having an issue with your MCOs not paying for Covid vaccine administration? Ours in Indiana are no longer just denying payment, but now completely writing it off. We have tried using and not using every modifier, code, etc. Still not getting paid… suggestions?
Are you billing 99072 (ADDITIONAL SUPPLIES, MATERIALS, AND CLINICAL STAFF TIME OVER AND ABOVE THOSE USUALLY INCLUDED IN AN OFFICE VISIT…) with those claims? We began getting denials if any Medicaid claim included 99072; once that was eliminated the claims have reprocessed without issue. Just a thought.
We are in Georgia. Amerigroup CMO is not paying. However, when we contacted them, they said they are working on a mass project to pay them. We will see…
medicaid wasn’t paying in VT, they said they were waiting for it to be approved, I escalated to our AAP chapter leadership and suprise, the next day it was “approved” and we should be getting paid this week for all our outstanding claims. Fingers crossed!
In Texas. One plan told us to bill with the vaccine code 91307 and the admin 0071A. If we have both lines in there, they said it will pay.
Other MCOs have no problem with just 0071A.
I would guess that all state medicaid plans must cover the COVID vaccine. Contact the state and the MCO will respond real quick.
When it is an MCO we receive denials.
Once the payment is denied we send to HRSA Covid 19 fund.
Will see if they pay
uh oh… we’re now experiencing this with Maryland Medicaid MCO where previously, payment was received. Our billing practices and coding has not changed. It appears to have started in November 2021:( What the H$$L!
When the kids vaccine came out, some payers did not have 0071A in their system yet. So we got some denials. But now the payers have corrected this problem.
Also I noticed that some payers were paying a fixed percentage of our billed charge for the vaccine admin codes. So update your billed charge to reflect that! One Medicaid MCO here is paying 54% of billed price for 0071A and 0072A.
Are you using the correct code for 5-11yr vaccine admin? It’s different from the 12+ code. The kids vaccine came out at the end of November.
No problems with coding as Medicaid has paid for 2022 vaccine claims using the same codes. Some explanation about "codes not entered in their system: in 2021 for the 5-11 yr olds. I guess that they figured it out by 1-1-2022. Still waiting…
Maryland Medicaid is now paying for COVID 19 vaccine claims for kids ages 5-11 yrs administered in November and December 2021.