Claim Denials for Immunizations Not Supplied by the State, CR 36421 & CR 38521 (workaround)

December 19, 2013

Immunization codes 90281-90399 and 90476-90748 have been denying due to National Drug Coding (NDC) editing. These codes should be exempt from NDC editing: There is currently a workaround in place to prevent the denial of additional claims. This workaround requires a process to override the NDC edit. This will occur at 1:00 PM every day. You will initially see the claim deny, but after the custom process is complete, the edit will be overridden and the claim will process. Claims will still be subject to all other applicable edits and may be denied for other reasons. Claims that deny due to the NDC editing prior to this workaround will be reprocessed and no provider action will be needed.