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We are getting a lot of claims denied for COVID shots and Flu shots. We check insurance before we send the claim to Patagonia. The insurance (and supplemental) will say eligible. Could someone help us understand what we are doing wrong to prevent claims showing denied and rejected. We don’t know what step we are missing. I try to work on claims that are denied and rejected. Someone else processes the claims. We have a list we go by for codes and proper billing procedures. Maybe someone could send us some tips PLEASE. Thank you.
Rita Mills
Not all of the insurance companies are up to date with bivalent codes, you may have to wait and resubmit. Make sure to use G0008 as your admin for all medicare flu. With some other adult vaccines, we have had to tack on a preventative services code
99395 18-39 years preventative visit
99396 40-64
99397 65+Those codes mean that not all of your information is on the claim. PTAN, NPI, Address, number, ect. The MA130 mean that claim is not processed and will not be you will have to make sure all the above is there and resubmit a new claim. The other code that you need to pay attention to is the one in the GRP/RC space. It will usually start with CO-### or PR-###, that is the biggest indicator of what is needed more than your MA and N codes.
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