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Ahcccs immunization billing

  1. #1
    Question Ahcccs immunization billing
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    Good Morning~

    Patient was seen, insurance provided at time of service was BCBS therefore we billed out regular priced immunizations provided by the provider. Later it was discovered that the patient had APIPA through Arizona's AHCCCS program. I understand we will only receive the $11.84 we are contracted for them to pay, however, they request we bill the immunization with a 'SL' modifier which means the vaccine was 'State Supplied' which they were not. There is much debate over if we should still bill with the 'SL' modifer or leave it off and appeal the claim. Typically when billing a primary with APIPA secondary we would not bill with the 'SL' modifier then so I feel billing the 'SL' is not correct billing in this case either.

    I was just wondering if the 'SL' modifer should still be added even though the immunizations were not actually part of the VFC program?


    Cheryl Miles, CPC

  2. Default
    I would not use the SL modifier like you said due to the fact that it is not properly used in the manner they are asking for it to be used and yes i would defintely appeal this based on your contract with the payer to be paid for the service

  3. #3
    I have tried various times to get the immunizations paid without the 'SL' modifier, however, I never have any luck actually getting them paid even after the appeal process. If they happen to actually pay they later come back and recoup the money based on the missing 'SL' modifier and then I have to start the process all over again... The only way they are actually paying without later recoupment is by adding the 'SL' modifier but this just seems wrong to me.


    Cheryl Miles, CPC

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