Update: Erroneously Denied Claims for Vaccines Billed With or Without SK & SL Modifiers

Originally published January 15, 2021
Updated September 28, 2021

The Department of Health Care Services (DHCS) previously published an article on January 15, 2021, informing providers of a claims processing issue which resulted in the erroneous denial of claims for vaccine codes when billed with or without SK and SL modifiers. A workaround solution had been implemented to stop the erroneous denial of the claims for dates of service from July 1, 2020, through August 1, 2021, until a permanent solution was implemented. This update supersedes the previous article as a permanent solution has been implemented.

DHCS is notifying providers that the permanent solution has been implemented which will ensure that claims billed with or without SK and SL modifiers will no longer be denied. Providers can continue to submit claims for processing and appropriate reimbursement. An Erroneous Payment Correction (EPC) will be implemented to reprocess all the denied claims which were affected by this systems error. No action is required of providers as the EPCs are automatically processed.

Note: The September 23, 2021 article update erroneously stated that an EPC has been implemented. An EPC is currently being installed to reprocess the erroneously denied claims and will be implemented at a future date. Providers will be notified when the EPC has been implemented. All other instruction and information within the article are correct.