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I just got off the phone with customer service for Healthy Blue on seven disputed claims. They are telling me that my CPT code for Admin fees are not right. Of course they paid the same CPT code in the first quarter of the year. They are saying that my codes are for serum.
Has anyone gotten a denial from them regarding the denial code DRAI? And the denial states Claim denied appropriately, serum available at no cost through VFC.
She even put a service line from another claim in back from May (and it paid) and now she says it comes back denied! Told her it sounds like a system glitch. Says I need to contact my rep!If you are administering VFC immunizations, the administration CPT code should not pay. Medicaid plans will pay approx $5.35 per antigen for the vaccine serum. Bill the vaccine serum with the SL modifier. The reimbursement from this counts as administration fee since the LPHA did not purchase the VFC vaccine serum.
Healthy Blue did pay admin codes incorrectly on several VFC claims that I had and I had to contact them and send corrected claims for them to recoup the overpayment.
All of my Healthy Blue VFC claims are being denied. I spoke to my rep on July 6 and she verified that there is a system glitch that is causing the codes to be denied. She told me to keep submitting my claims and when the glitch is fixed, Healthy Blue will go back and reprocess all of my denied claims. My rep said she didn’t know how long it would take to get the glitch fixed.
My claims in April and May were paid. Since June they have been denied, and I am using the SL modifier.
Anytime you have unresolved issues with any of the Medicaid plans call MC+ Contract Compliance and file a complaint. 573-526-4274 or 573-522-9859. This office will get these issues resolved.
I am still fighting with not getting paid for my vaccines. So frustrating… I haven’t gotten paid for any immunizations yet this year.
All billers – please call or email MC+ Contract Compliance with MoHealthnet if you are having problems getting immunizations paid by Healthy Blue. If you have done your due diligence and talked to the managed care company and are still not getting paid correctly, PLEASE FILE A COMPLAINT. Either by phone 573-526-4274 or email: mhd.mccommunications@dss.mo.gov The more complaints to the state oversite, the more leverage they have to get the managed care company in gear and paying as they are supposed to.
I filed a complaint and within 2 days Healthy Blue contacted me and sent a spreadsheet with all my claims that were reprocessed that day. Healthy Blue is also supposed to be reprocessing the immunization claims not paid correctly every two weeks. Healthy Blue knows they have a problem but are dragging their feet in fixing it and paying these claims. They do not want a bunch of complaints to the state because it will look bad next time the contracts are up for bid. File complaints – it should get the problem fixed quicker.
Thank you for the information. They had been paying just fine until the last month. I keep getting odd denial codes.
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