Medicaid pharmacy flu billing revised remittance advice 2019

[Missouri Public Health Association]

I got a remittance advice from Medicaid for flu shots given to adults in 2019, they have taken back what they originally paid for vaccine and have paid a lower amount resulting in money they have taken back. Has anyone else had this happen recently? Reason stated is below:

Reason code 45: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)
Start: 01/01/1995 | Last Modified: 07/01/2017
Group Code CO Contractual Obligation
Start: 05/20/2018

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