Wiki Wi vfc program

[jeaner54175@yahoo.com]

Our clinic is a FQHC and participates in the VFC program. We are unable to get reimbursed from Medicaid for the administrative code. I called Forward Health and I was told to use another administrative code and leave modifier SL on the vaccine given along with a $0 dollar charge. I changed the administrative code to 90460 and the claim is still be denied. It is still denying for the wrong administrative code used and now diagnosis used which is Z23. Below is an example of the codes used. Does anyone have any suggestions on how to get the claim paid or is this something that needs to wait until the cost report is due? Also, if the clinic isn't part of the program for what ever reason could that also cause the denial.

Diagnosis: Z23
Flu vaccine: 90658 - SL $0.00 dollar amount
Administration: 90460

Thank you,
Lisa

 

[mcleereman]

Wisconsin Medicaid will pay for the administration but they pay it on the serum. Leave your full charge on the serum and $0 the admin. They will pay the administration rate back on the serum line item.