I have two payers that have refused to pay for Covid-19 administration for my OON provider. Even though the admin cpt code is correct and the NDC# is correct. I have to file Appeals for them to reconsider their denials. I can not find exactly where in the law it says Private Health insurance plans are to pay in-network and out-of-network providers. Can anyone point me to where the law exactly says this? Has anyone else had this problem? If so, how did you get the claim paid?
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Wiki Insurance Plans Not want to Pay for COVID-19 vaccine Administration
- Thread starter Sbest
- Start date
OpenClaims
Guest
We'll need more information for this. What insurance does this refer to? Was this billed with an E/M? If so, have you appended modifier 25 to the E/M for the administration?