Update on NC Medicaid’s Vaccine Administration Re-Processing

The NC Department of Health and Human Services, Division of Medical Assistance (NC DMA) is currently working to reprocess vaccine administration claims as part of last year’s ruling on a suit filed by the NCAFP, the NC Pediatric Society, and several pediatric practices. According to our most recent information, NC DMA is anticipating July for the reprocessing, slightly behind its original June target. The NCAFP and NC Pediatric Society have strongly urged NC DMA to test the process in a reversible manner to verify only the 90472,4 administration codes would be affected. DMA plans to test multiple practices and likely a sample of claims from a few additional practices. The practices will be asked to review the test claims to make sure the current edits did not invalidate the old 2013 and 2014 claims. If claims were inappropriately recouped and not repaid, the test can be discarded and repeated until only the 90472,4 administration fees are paid back at $20.45 instead of the original $13.71. The NCAFP will keep members updated as we learn more.