Wiki Denial for Gardasil vaccines for a 33 y/o male

[ellistneal]

I can't get pass this denial with Oscar for a three series Gardasil vaccine. Claims are being denied stating "Per NCCI guidelines, the units for this procedure on this claim line exceeds the maximum allowed for the same date of service. Units up to the allowed maximum are processed. Units in excess of the maximum allowed have been denied."

Patient has no history of previous Gardasil vaccine and we've administered two so far that have been denied. What do I do?

 

[sls314]

I can't get pass this denial with Oscar for a three series Gardasil vaccine. Claims are being denied stating "Per NCCI guidelines, the units for this procedure on this claim line exceeds the maximum allowed for the same date of service. Units up to the allowed maximum are processed. Units in excess of the maximum allowed have been denied."

Patient has no history of previous Gardasil vaccine and we've administered two so far that have been denied. What do I do?

Are you billing them all on the same date of service? The denial description you've given sounds like an MUE denial, which shouldn't be happening unless you're billing more than the MUE for the same DOS.

Of course, there's also the possibility that the payer is denying for a different reason and just using an inaccurate denial remark code.

 

[ellistneal]

We billed two vaccines on different dates. Yes you are correct this is a MUE denial. I'm not quite clear on what this means.

 

[slc112071]

I can't get pass this denial with Oscar for a three series Gardasil vaccine. Claims are being denied stating "Per NCCI guidelines, the units for this procedure on this claim line exceeds the maximum allowed for the same date of service. Units up to the allowed maximum are processed. Units in excess of the maximum allowed have been denied."

Patient has no history of previous Gardasil vaccine and we've administered two so far that have been denied. What do I do?

How many units are you billing? Also, verify on the units on the NDC that is going over on the claim. We have had denials for that.