# Why is Medicare rejecting Covid Vaccines? Please help!



## michelleaapc2012 (Jan 20, 2021)

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.


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## SharonCollachi (Jan 21, 2021)

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*


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## tjking1 (Jan 25, 2021)

michelleaapc2012 said:


> 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
> ...


Ours  too in Alabama!!  Think it needs a referring?  As in the ordering referring like the labs?


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## SharonCollachi (Jan 25, 2021)

If you don't have a referring doctor, put your own doctor's name in there.


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## jbhuju (Feb 21, 2021)

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.


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## sls314 (Feb 22, 2021)

jbhuju said:


> 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.



It should be billed to Original Medicare.



			https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration


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## Lucinda1204 (Mar 22, 2021)

sls314 said:


> It should be billed to Original Medicare.
> 
> 
> 
> ...


Hi, We have not billed for administration of the vaccines.  How about documentation if you don't mind sharing.


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## jgargiulo (Mar 30, 2021)

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?


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## SharonCollachi (Mar 30, 2021)

jgargiulo said:


> 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?


If all that is happening is the vaccine, there is no 99211 as well.


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## tjking1 (Apr 1, 2021)

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.


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## rthomas@impcna.com (Apr 2, 2021)

tjking1 said:


> 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-
> 
> ...


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.


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## erjones147 (Apr 2, 2021)

Our facility has for a few months


tjking1 said:


> 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-
> 
> ...


Our facility has for a few months. Very persnickety to start, but seems to be moving smoothly now


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## tetzel@berkschc.org (Apr 23, 2021)

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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