Pediatric Coding Alert

This practice confirmed whether its payers were ready to accept vaccine claims.

If your insurer hasn't said a peep about whether it will accept the new vaccine administration codes 90460-90461, you should contact the provider relations department directly. That's how Bonnie Palmer with Lawrenceville Pediatrics in Georgia determined which claims she should submit now, and which she should hold onto.

Palmer's local insurers gave her the following advice on submitting claims. If you'd like to follow her lead and determine which payers are reimbursing for vaccines, contact all of the payers with whom you are contracted and ask them for specific advice on the new codes. In addition, she adds, "I would recommend that offices only send a few claims to see how they are processing before they send hundreds and find out that they are all denying."

• Blue Cross and Blue Shield of Georgia has the new codes loaded into its systems for all claims withdates of service on or after Jan. 1, 2011 -- however, the insurer initially asked practices not to submit these claims until Feb. 3, 2011. If you billed the new codes prior to Feb. 3, the system denied the second or third unit of 90460 or 90461 as a duplicate and you'll have to call the claims department and have the claim reprocessed for correct payment.
• The claims systems for Aetna, Humana, Guardian, Taylor Benefit Systems, and Coventry Health Care are all ready to accept the vaccine claims for all dates of service on or after Jan. 1, 2011.
• The United Health Care Web site indicates that practices should not use the new codes until April 1, but Palmer was told by a UHC rep. that this information was posted to the Web site incorrectly. The UHC rep. advised her that the insurer's system is actually capable of handling the new codes now for all dates of service on or after Jan. 1, 2011. If you did bill your vaccine services with the old codes based on the erroneous information on the UHC Web site, you'll have to rebill all of those claims with the new administration fees and write "Corrected Claim" at the top of your claim form, Palmer notes.