Reprocessing of Erroneously Paid and Denied COVID-19 Vaccine Administration Claims

The Department of Health Care Services (DHCS) identified a claims processing issue affecting COVID-19 vaccine claims billed with Bivalent and Monovalent administration codes. This issue caused some claims to erroneously pay and some claims to erroneously deny with Remittance Advice Details (RAD) code 0008: The provider of service is not eligible for the type of services billed and 0225: This is an incorrect procedure code and/or modifier code for this service; please resubmit, resulting in both claim overpayments and denials. The issue affected claims for dates of service on or after April 18, 2023.

Source: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/24BD9192-1894-41E0-BBE9-2A1354F2B154/32557_p44665.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO