Providers may need to resubmit incorrectly denied COVID vaccine claims for payment

Between August 2023 and February 2024, some COVID vaccine claims were denying when they shouldn’t.

Our teams identified and resolved the root cause of the issue, automatically reprocessing for payment. However, some providers have identified claims that weren’t reprocessed.

Identifying impacted claims

Impacted claims include those for CPT codes 90480 and 91318-91322 with denial codes Q01 or Q02 (Not Contracted) or clinical edit y28 (Invalid HCPCS procedure).

How to get paid

If you’ve identified any applicable claims that weren’t reprocessed, please follow the instructions in our Provider Manual for resubmitting claims.

We value your partnership and the care you provide our members, and we sincerely apologize for any inconvenience this has caused. Thank you for your patience and understanding.