Wiki RE: Healthchoice Medicaid claims

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Kar116

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RE: Healthchoice Medicaid claims

I am about to pull my hair out trying to get these Medicaid well child vaccines to pay!
We have had a slew of claims that denied for either NDC, #units, for all the vaccine codes. I have to send a paper claim since they want corrected claims sent on paper. Can someone tell me what I am doing wrong as far as coding it and putting the correct ML units?

This is the one I am working on right now:
90460-SL $32.00 (2) units
90461-SL #32.00 (2) units
90707-SL $16.00 (1)
N400006468100 ML1
90716-SL $16.00 (1)
N400006482700 ML1
90633-SL $16.00 (1)
N458160082552 ML1
99392-25 $150.00


The only charge they paid for is the well child visit. Anyone out there work in the state of Arizona and dealing with Healthchoice? I've followed their website and it still denies. What am I doing wrong/can't get anyone at the insurance company to give me any guidance! Help please!
 
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AZ Medicaid

It looks like the order of your lines is wrong. In the example in the Chapter 10 Provider Manual, it shows to list the administration code first, and then the vaccine if the date of service is on or after 1/1/13 due to a change in the law on how immunizations are reported to AZ Medicaid. No NDC number needed as the state provides the drug.

Try this order and see what happens. Remember to put 0.00 in charge column for lines 2,4,and 6.

1. 90460-SL
2. 90707-SL
3. 90461-SL
4. 90716-SL
5. 90461-SL
6. 90633-SL
7. 99392-25

Here is a link to the manual for Chapter 10. Start on page 12/43.

http://www.azahcccs.gov/commercial/Downloads/FFSProviderManual/FFS_Chap10.pdf

If it works, I would print this section out and hang it up in the billing department for easy reference.

Hope it works. I have helped others with AZ Medicaid issues they were having regarding billing with Mental Health H codes. I don’t know why AZ Medicaid is so difficult to bill with. Good Luck.

Oh, be sure to read the section I found on AZ Medicaid website: (Link is below)

Provider Vaccine FAQs
Updated Vaccine FAQs supersede the Vaccine Memo to Providers
• Vaccine FAQs 3/29/13
• Vaccine Memo to Providers 2/11/13

Link: http://www.azahcccs.gov/commercial/ProviderBilling/rates/PCSrates.aspx
 
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Thank you for your help Airart! I will need to get with our doctor since she has been doing all the coding for the office. I don't know why it has been such a pain with all the Medicaid bills, I ended up putting a notebook together of all insurance plans since every insurance plan has specific guidelines on how they want things coded. Care 1st is the only plan that I see who does not require the NDC codes so their billing is much easier to deal with. Thanks again! :)
 
Our Medicaid system in WA State will not pay for the counseling codes; just reimburse for the admin (which is actually billed with the toxoid code and the SL modifier). But it appears maybe other states are paying for counseling?
 
Yes KMayes, it is units--I've been billing 1 unit for each vaccine code. I am going to send it out again and see if it goes thru this time. Thanks!
 
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