MedicaidBilling CodesHigh impact
[Ohio] Getting VFC claims right: billing and reporting reminders
Anthem BCBS·OH · Pediatrics, Family Medicine, General Practice·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 3, 2026
Summary
Anthem Ohio Medicaid/MyCare Ohio will reimburse the administration fee for VFC vaccines for eligible members under 19, but NOT the vaccine serum (provided free). Claims must include both serum code(s) AND administration code(s) with appropriate modifiers for HEDIS reporting compliance. Claims missing required codes will be denied.
Action Required
By August 1, 2026: Billing team must audit all VFC vaccine claims to ensure compliance. SPECIFIC ACTIONS: (1) Verify billing software is configured to include serum codes AND administration codes with modifiers on all VFC claims for members under 19; (2) Update claim scrubbing rules to flag claims missing either serum or administration codes before submission; (3) Train billing staff that vaccine serum itself is NEVER billable (already provided free through VFC), only the administration fee is reimbursable; (4) Review current claim patterns to identify any submitted without complete coding; (5) Communicate to providers that incomplete coding will result in claim denials. CONSEQUENCES: Claims submitted without applicable serum codes, administration codes, and modifiers will be deemed ineligible for reimbursement and denied.