Modernize the Vaccine Process and Roster Billing - Full Agile Pilot CR
The purpose of this Change Request (CR) is to create a modern and fully automated process to implement vaccine codes across Medicare Shared Systems and CWF when new HCPCS and/or CPT vaccine codes are developed. This CR will also serve as a medium to develop a fully automated and streamlined in-house roster billing process that interfaces with Parts A & B Shared Systems.
The current process to implement new vaccine codes is achieved through Technical Direction Letters that instructs Medicare Administrative Contractors (MACs) to manually load vaccine codes (including pricing and descriptors) and add the vaccine codes to existing edits and/or bypass existing edits.
This CR will implement new vaccine codes in a more efficient manner, reduce the burden of manual intervention by the MACs, and bridge the gap of how the roster billing process works across Parts A & B systems.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 31, 2024
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