Tag: #covid19vaccine

Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP (NY) COVID-19 Vaccine Proper Billing and Coding guidance

Posted on by KR2Medical Billing

The following medical billing and coding Guidance, for COVID-19 vaccines, ONLY applies to New York Providers.

As per MVP: ALL COVID-19 vaccines are covered for all PLANS without a member cost-share.

In order to get reimbursement, providers need to follow the proper COVID-19 vaccine billing and coding guidance.

For MVP Medicare Patients:

Providers please bill Medicare Fee-for-Service (FFS) directly for the vaccine and administration of the
vaccine to MVP Members enrolled in Medicare Advantage in 2020 and 2021. If Providers will bill the COVID-19 claims to MVP, they will be denied.

For MVP Commercial and Managed Medicaid Patients:

Since COVID-19 vaccines are provided by the government at no charge, Providers should not bill the Vaccine codes (please see below Picture 2). Instead providers should only bill the administration codes (see below Picture 1).

(Picture 1)
(Picture 2)

MVP will reimburse both In Network and Out of Network providers.

Posted in Insurance, Training, Updates

EmblemHealth (NY) COVID-19 Vaccine and Monoclonal Antibody Infusions Policy

Posted on by KR2Medical Billing

Effective 11/09/2020 the following are the guidelines for COVID-19 Vaccine and Monoclonal Antibody Infusions for various EmblemHealth Product lines:

  1. Commercial Plans- EmblemHealth will cover the costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. Reimbursement will be based on CMS published rates. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.
  2. Medicare Advantage Plans- charges for administrating the COVID-19 vaccine should be billed to your local MAC (Part B). The MAC will reimburse claims for Medicare members with no cost share for the remainder of 2020 and through 2021 If the provider will bill the claims to EmblemHealth the charges will be denied and the provider will be informed that the charges need to be submitted to the local Part B MAC. (If you are a provider located in NY the local Part B MAC is NGS- national government services).
  3. Medicaid Plans- EmblemHealth will cover costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.

Partial List applicable to this reimbursement policy:

For the complete policy and the complete list of applicable codes, please click here to visit the policy.