Wiki Immunization remittance

[mclaintr@gmail.com]

I am new to aapc and not sure if this is where i can ask for help. In the last two months i have had tricare shots denied as "not fda approved". Mostly hep a, tdap, gardasil and the oral rotavirus. Can anyone advise me why this is happening? Or direct me on where to ask for help

thanks so much
tonya

 

[roxvaughn]

I would contact them directly and dig into it a little more on their end what the issue really is. Are you sedning them the NDC numbers? That could possibly have something to do as well.

Roxana Bejinariu, CPC, CPMA

 

[meenda]

You need to add the NDC numbers, but they need to be in 5-4-2 format....so if you have an NDC that is 9999 999 99 you have to add ZERO's where the missing numbers are: 0999 0999 99 You ALSO have to list ONE UN (UNIT) or ONE VIAL.
They will deny them until you get this set up, and you will have to call on every single one to get them paid!
I had to get some help from my billing software company, so that they attached the corrected NDC right to the cpt code, so I didn't have to type them in every single time.
I feel your pain!

THT

 

[mclaintr@gmail.com]

Thanks so much for the thoughts. I have the NDC #s, even in the correct format.. And the units. When I call tricare they claim the CPT codes are not FDA approved. I'm at a complete loss.

 

[Cynthia Hughes]

Could be a system error at Tricare but you might double-check that your codes are accurate for the products (good resource is https://www.aap.org/en-us/professio...at-the-AAP/Documents/Vaccine Coding Table.pdf) and then pursue further with Tricare.

 

[mclaintr@gmail.com]

Thanks. I'll research the link.