Wiki Why is Medicare rejecting Covid Vaccines? Please help!

michelleaapc2012

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Medicare is rejecting all of our claims with:
A3 : Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
23 : Returned to Entity. Note: This code requires use of an Entity Code.
SMARTEDITDOCPROCEDURECODE0011AMAYREQUIREADDITIONALDOCUMENTATIONFORPROCESSING

We are billing 0011A with Diagnosis Z23

At first we were billing 0011A and 91301 with Diagnosis Z23 and got rejections. Then we learned that we are supposed to only bill 0011A. Now those are rejecting. Please help.
 
Here is what I found:

The claim has been rejected at the payer's end for an entity issue. With this rejection reason, the payer should send additional information indicating who the 'Entity' is. Unfortunately, sometimes this information is not included.

The Entities that may be involved are:
  • Billing Provider
  • Rendering Provider (Address and Phone are not included on claim, but they may be referencing the NPI).
  • Member/Client/Patient Insured
  • Referring Physician
 
Medicare is rejecting all of our claims with:
A3 : Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
23 : Returned to Entity. Note: This code requires use of an Entity Code.
SMARTEDITDOCPROCEDURECODE0011AMAYREQUIREADDITIONALDOCUMENTATIONFORPROCESSING

We are billing 0011A with Diagnosis Z23

At first we were billing 0011A and 91301 with Diagnosis Z23 and got rejections. Then we learned that we are supposed to only bill 0011A. Now those are rejecting. Please help.
Ours too in Alabama!! Think it needs a referring? As in the ordering referring like the labs?
 
Last edited:
we are billing those two codes to medicare and yes we are getting paid. but medicare advantage or supplement is not paying stating that needs to bill to regular medicare.
 
good morning all question
for nonpar providers can you still bill Medicare directly also can you bill for any payers the nurse visit 99211 as well?
 
Has anyone billed the COVID Vaccine Administration to the Provider Relief Fund for the vaccine that has been provider by the federal government?

From the CMS Tool Kit-

COVID-19 | CMS
People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the HRSA COVID-19 Uninsured Program.
 
Has anyone billed the COVID Vaccine Administration to the Provider Relief Fund for the vaccine that has been provider by the federal government?

From the CMS Tool Kit-

COVID-19 | CMS
People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the HRSA COVID-19 Uninsured Program.
I have not bill vaccine administrations (we just got vaccines in yesterday) but I have billed E/M visits and testing. We have not had any issues with getting patients approved or getting claims paid.
 
Our facility has for a few months
Has anyone billed the COVID Vaccine Administration to the Provider Relief Fund for the vaccine that has been provider by the federal government?

From the CMS Tool Kit-

COVID-19 | CMS
People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the HRSA COVID-19 Uninsured Program.
Our facility has for a few months. Very persnickety to start, but seems to be moving smoothly now
 
Can anyone tell me how you are billing "Incident To" administration of COVID vaccine? More importantly, does your physician have to sign every vaccine administration document or how are you doing that?
 
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