2011 Immunization Admin Letter for Payors

I could probably publish a full-time blog just on the materials that The Verden Group produces.

The latest comes from an effort on SOAPM to construct a letter that every pediatric practice should send to ever payor to which it submits claims in order to jump start the process of finding out how imms admin coding will work in 2011.  There are a lot of unanswered questions right now and the imms admins codes are the 4 of the most common 5 pediatric CPT codes.

First, the pre-amble and explanation:

Well, this took a little longer than I hoped, but attached please find a template that you can use to send to the CEOs and Medical Directors at the plans in which you participate.

A big THANK YOU to Dr. Jesse Hackell, who assisted me with this and helped create the content (enjoy Paris, Jess!)

In this letter, you will note sections in red – those are the elements that you will need to fill in / modify. For those not too MS Word savvy, double-clicking on the header (where it says ‘your practice name and address here’) will allow you to edit that text and drop in your details / logo.

I’ve also incorporated language regarding reporting HIPAA violations and filing complaint under prompt pay laws for your state (see Jill Stoller’s latest post). If you need to file a HIPAA complaint, you will find information on how to do that here and click on the magnifying glass icon / text on the left-hand side of the page.

PLEASE FEEL FREE to edit the letter in any way you see fit to suit your needs / comfort level.

Next, where and to whom to send the letters? Do a google search for the parent insurance company and navigate to the ‘contact us’ page. You’ll find the corporate address listed there. Send the letter to the CEO to that address. Next, call the corporate number and ask who the Medical Director is for your region and where you can send a letter to them. Usually they will give you this information. For anyone having difficulty tracking down information, we have a (slightly outdated, 2009) dataset but it is copyrighted so I can’t just post the whole thing here. However, I can release portions of that data upon request, so please email me offline with the insurance company for which you need help and we can get that information to you / posted here.

I am looking forward to hearing what responses you receive from the Payers, and how promptly. Hopefully this will prompt them to take immediate action. At the very least, it puts them on notice that you are aware, organized, and willing to take action against them!

Enjoy.

Susanne Madden, President & CEO
The Verden Group

My only question about the letter, which is otherwise superb, relates to the AAP’s comment that electronic claims have a limit of 8 codes…which they don’t. I’d just recommend changing the word “electronic” to “paper” in there.

PLEASE PLEASE PLEASE share any responses you receive!

Oh yeah, here’s the letter!

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