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What is everyone billing for flu vaccines, I normally bill $6.00 and receive $5.35 back. But Healthy Blue paid $6.00. Has the vaccine prices to bill gone up?
Medicaid updated their fee schedule on immunizations. They now pay $8.07 for a single vaccine. Different amounts for combination vaccines.
We can never get healthy blue to pay anything… can you send me a copy of a superbill with the cpts and modifiers you use that work to get payment?
https://dss.mo.gov/mhd/ go to Providers and you can find fee schedule there
I never got a provider update from MoHealthNet, but I got an email from Healthy Blue about it, and that’s how I found out. I just went to the Provider fee schedule to find the new rates and then updated our fee schedule in our EMR.
Here’s our new immunization fee schedule effective 7/1/22:
CPT Modifier Inpatient Charges Outpatient Charges
90620 SL 8.07 8.07
90633 SL 8.07 8.07
90647 SL 5.35 5.35
90648 SL 8.07 8.07
90649 SL 8.07 8.07
90651 SL 5.35 5.35
90670 SL 8.07 8.07
90681 SL 8.07 8.07
90685 SL 8.07 8.07
90686 SL 8.07 8.07
90696 SL 32.26 32.26
90700 SL 24.2 24.2
90707 SL 24.2 24.2
90710 SL 21.4 21.4
90713 SL 8.07 8.07
90715 SL 24.2 24.2
90716 SL 8.07 8.07
90723 SL 40.33 40.33
90734 SL 8.07 8.07
90744 SL 8.07 8.07Here’s the email:
Dear Healthy Blue Provider,
Healthy Blue would like to provide you with information regarding the professional fee schedule rate updates that were effective 7/1/22. Although state bulletins were recently published with increased rates that were retro-effective 7/1/22, please note that the updates were still pending CMS approval. As a health plan, Healthy Blue could not implement the rate increases without CMS approval, which is why claims have continued to pay the old rates.
CMS has since approved the rates, and the approved fee schedules were published on the state’s site on 10/31/22. Currently, Healthy Blue is diligently working on auditing the updated fee schedules and loading them into our claims processing system. Once this is complete, Healthy Blue will reprocess incorrectly paid claims from 7/1/22 to pay the updated rates. You do not need to submit claim payment disputes regarding the updated rates as Healthy Blue will be reprocessing all incorrectly paid claims on our end upon system update.
Please let me know if you have any questions.
Thank you,
Elevance Health
Christa Hudson
Provider Experience Consultant
272 S Mt Auburn Rd, Cape Girardeau, MO 63703
M: (573) 270-1307 | F: (573) 339-5149
christa.hudson@healthybluemo.com | Healthy Blue Provider WebsiteHope this helps!
I just realized a couple of those CPT code fees didn’t get changed. This is because we don’t use them anymore, so I just didn’t remember to change them.
I was told the Managed Care plans have 60 business days from Nov 1 to get their systems updated with the new fees per their contracts. The plans will then do a mass adjustment. I did get paid the $8.07 in today’s payments from Healthy Blue and United HealthCare so hopefully the mass adjustments will be done shortly.
The fee schedule was updated 7-1-22 but CMS had to approve. New fee schedule was just updated 11-1-22 on https://dss.mo.gov/mhd/ go to Providers.
Hope this helps.
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