AMA billing tips:

• 13.59V may be claimed in a physicians office when they are supervising qualified staff to provide the injection or when they provide the injection themselves. 13.59V is NOT billable in an AHS mass vaccination clinic where the physician is supervising multiple staff. In this instance, physicians may ONLY bill for the vaccinations that they provide themselves. Physicians must be sure to record the vaccination they have provided or have supervised in the Immunization Direct Submission Mechanism as there are fines starting at $100,000 for the first offence for failure to record the vaccination.

• Claims for non-entitled residents (PQ, out of province, non registered Alberta residents or out of country) may be submitted for 13.59A or 13.59VA, should be submitted as follows:

  • The ULI field should always be blank.
  • The person data fields must be completed in full.
  • The OOP registration number should be in the appropriate field with a corresponding ‘recovery code’.
  • OOP resident claims for covid injections should be submitted as medical reciprocal but text is required to hold the claim for manual review. If there is no text, the system will automatically reject the claims as medically excluded.
  • Some EMR systems will not allow a submitter to submit with both the ULI and registration number fields blank (for non-residents / PQ). In this case, enter 9 zeros in the registration number field with a corresponding recovery code of SK and the appropriate text (even though they may not be a SK resident). This has been tested and will work BUT it is essential that the text and personal data be included as it is used to then modify the claim correctly upon receipt.

  To be clear, as per Gen 126, text is required on all claims for non-entitled residents (PQ, out of province, non registered Alberta residents or out of country). Text is to include all insurance eligibility (whether that is an out of country insurance company name and number that the physician obtained from the patient, an AHS assigned ULI OR if using all zero’s in the registration field, the patient’s OOP registration number).