A claim processing issue has been identified that potentially impacts all Cohort 1 Primary Care First (PCF) participants that submitted claims for flat visit fee (FVF) eligible services processed between January 1, 2021, and February 3, 2021.
A claim processing issue has been identified resulting in cost sharing being applied to COVID-19 vaccine and mAb claims when submitted on TOB 12X, 13X, or 34X. This article was modified July 28 for provider action to address the reprocessing of claims.
During the public health emergency, CMS amended regulations to remove the requirement that certain diagnostic tests are covered only when ordered by the treating physician. Additional codes have been added that do not require an ordering provider on the claim.
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