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Hello,
We are having issues with Healthy Blue denying CPT code 90677 SL (Prevnar 20). The reason for denial is: Needs proper administration code. This is the only CPT that they are denying, all other CPT codes are being paid.
Thank you,
Michelle Lewis
Columbia/Boone County Dept of
Public Health and Human ServicesYes, we are being denied for it also. sent 2 back for reconsideration and denial was upheld – “Per coding guidelines to report the vaccine code, the vaccine/toxoid product codes must be used in addition to an administration of vaccine/toxoid.”
I wonder if they have not updated their system to include Prevnar 20 for children?
Carol Wells
Lafayette County Health DeptI too am having the same issue, but we also were getting denial for 90671 for the Prevnar 15.
I have reached out to Healthy Blue and they have our provider relations person working on it. I am expecting a call or email early next week. I’ll let you know what I find out and please update if you figure anything out.Thank you for letting me know. We reached out to MOHealthnet yesterday and they had us fill out a the Managed Care Provider Information Request form on Emomed. Here is the link:
https://mydss.mo.gov/media/pdf/managed-care-provider-information-request
This from allows you to tell MoHealthnet what issues you are having with any of the Managed Care Plans. I will let you know what we find out.
Thank you,
MichelleFYI,
Healthy Blue went back and corrected all of our denials on 90677. We just got the new remit yesterday. So the Managed Care Plan form on Mohealthnet worked!!Michelle Lewis
Just received email re 6077 denials – to pay them. Ticket has been submitted to fix system – target release date is 6/14/24 – once ticket has been completed, a claims sweep will be submitted to reprocess impacted denials.
Filling out a Managed Care Provider Information request really worked. Thank you for everyone’s help!
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