LADY_SETSUNA_CJ
Guest
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
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