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April, 2014

Denials of Vaccine Admin Codes

Some of you have been noticing denials for vaccine administration (90460-74) when delivered during preventive services, CPT codes 99381-99397. Attached is a description of this activity from the national AAP for Medicaid.


This started happening in Medicaid back in early 2013, but CT's Dept of Social Services was able to deactivate those codes. Unfortunately, CMS has stated that they are mandated to use the modifier 25 to the preventive E&M code no later than April 1, 2014.


To further complicate this, commercial insurance carriers are picking up this practice, as they want to aligning their private and Medicaid coding internally. While these companies don't have any Medicaid in CT, they do nationally, so that is why they are doing it. (We know that United Health Care is doing this. Not sure of any others at the moment)


We do understand that many coders believe this is incorrect coding, it is the rules we now have to live with


We understand that the commercial payers will pay if the billing is resubmitted.


Medicaid NCCI Edits for Immunization and Preventive Medicine Codes.

Understanding the CT Marketplace 

"access health CT"


The Affordable Care Act (ACA) 

is well underway with the CT marketplace, access health ct, up and running.  We at eBenefits Group are certified and ready to help you with your health insurance needs on and off the marketplace or, as it is also referred to, the exchange.  There are two parts to the marketplace, individual and group which is referred to as SHOP.  There are definite benefits for some individuals and groups who may qualify for a subsidy or tax credit.


Most people are aware of the individual mandate and know that the open enrollment period will continue through 3/31/2014.  Individuals can go online through access health ct to obtain insurance and find out if they qualify for a subsidy.  We at eBenefits Group are happy to assist anyone who needs help with this process.


What most people aren't aware of is how to obtain the small business health care tax credit for small businesses and tax exempt organizations.  For tax years 2010 through 2013, the maximum credit is 35% of premiums paid for small business employers and 25% of premiums paid for small tax-exempt employers, such as charities.  The credit may equal up to 50% of the qualified premiums paid by eligible small businesses and 35% for small tax-exempt businesses in 2014.


Who is eligible for the credit?  Employers that

  • Pay at least half the cost of qualified "single" (employee only) health insurance coverage for their employees,
  • Have fewer than 25 full-time-equivalent employees.  For example, two half-time workers count as one full-time-equivalent employee, and
  • Pay wages averaging less than $50,000 per full-time-equivalent employee per year.
  • You will have to purchase insurance through the SHOP marketplace to be eligible for the credit for tax years 2014 and beyond.


How do you claim the credit?

Small businesses and tax-exempt organizations use Form 8941, Credit for Small employer Health insurance Premiums, to calculate the credit.  Your accountant can help you with this.


It is imperative that employers now begin to understand all of their health insurance options in and out of this new marketplace, and how they will be impacted going forward.  We at eBenefits group will stay abreast of these ongoing regulations and are here to help you stay informed.  As always, please don't hesitate to contact us with any questions or concerns you may have. 



eBenefits group Northeast, LLC.




Medicaid EHR Incentive Program Survey

The University of Connecticut Health Center is working with the Connecticut Department of Social Service's Medicaid Electronic Health Record (EHR) Incentive Program to engage and bring awareness of the EHR Incentive program to the provider community.  Through the DSS Medicaid EHR Incentive Program, eligible providers may receive up to $63,750 in incentive payments over the course of six years.  In addition, we want to help eligible providers meet the necessary requirements so that they can receive the maximum incentive payments within the allotted time period. 


This short 10 minute electronic survey will help us understand the current barriers you face in achieving Meaningful Use and/or any other important stages in the process.  Your partcipation is voluntary.  Our goal is to reach out to as many eligible professionals as possible and help them benefit from the Medicaid EHR Incentive Program.

Save The Date
28th Annual Clinical and Research Meeting (ACRM)


North American Society for Pediatric and Adolescent Gynecology (NASPAG)  


April 24-26, 2014

Loews Hotel

1200 Market St.

Philadelphia, PA 19107


The ACRM is designed for primary care physicians, specialists, nursing and allied health professionals, and physicians in training whose practices include pediatric and adolescent female patients and/or whose practices include the gynecologic care of pediatric and adolescent patients. The course will consist of keynote sessions and concurrent presentations addressing critical issues in pediatric and adolescent gynecology, surgery, endocrinology and sexuality. The faculty and participants will interact in a variety of formats, including formal and informal group discussions, oral and poster sessions and lively debates in order to disseminate the latest information concerning pediatric and adolescent female patients. In addition, interactive sessions will include video format presentation.


For more information please visit our website at: http://www.naspag.org/index.php/pagecourses 

Jillian Wood
Executive Director

Tracey McDougall
Webinar Coordinator

Yvette Moretti
Marketing & Communications Manager

Kathryn Senk
Office Manager

Judith Blei
Government Relations

104 Hungerford Street
Hartford CT 06106

In This Issue
Quick Links
See what you've Missed: Listen to any 2013 Webinar meeting
National AAP
Advertise Your Group's CME Programs to CTAAP Members

Take advantage of a great new opportunity to post your continuing medical education classes on CTAAP's website.  Please complete the Statewide Pediatric CME Form and send it to yvette.ctaap@gmail.com

PHONE: 860-525-9738   FAX: 860-727-9863   E-MAIL   104 Hungerford Street   Hartford, CT  06106

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