How do I setup to bill through my PMS?

The Third-Party Plan for live submission through the Pharmacy Management System will need to be verified. The software certification code (Cert ID field) is FDSMEDB208 for MEDBILL users and EZDME0810D for EZDME users. The BIN which is used to transmit claims with either solution is 007895. This will ensure claims are routed to FDS correctly.

For MEDBILL users, we have specific instructions for Pioneer, BestRx, RX30, Computer RX as well as general PMS platforms. These guides can be found by logging into the MEDBILL platform and going to the menu item “Resources” then clicking on “COVID-19 Vaccine Billing."

What PCN should I use?

When you are billing vaccines (any type) to Medicare you need to use the PCN with the code FLU followed by state abbreviation. [Example: “FLUMA” for Flu Massachusetts (this includes COVID-19 vaccines.] You may also use the generic “FLUXX” however you will not be able to reverse the claim if needed.

If you are billing vaccines to Commercial or state Medicaid payers, you should use the PCN included in the payer setup email you received from FDS.

How do I bill for COVID-19 services for patients with Medicare Advantage Plans?

Bill to the FLU PCN and make sure to use the Submission Clarification Code “02” (420-DK) to override eligibility.

Should I use the NDC or the HCPCS to bill for COVID-related services?

If a product has an NDC, the preferred method of submission is to send the NDC as the Product Identifier with the claim.

We now have the Janssen vaccine – how should I bill?

Use the Janssen NDC as the Product Identifier with the claim. For your reference, here are the NDCs for the most COVID vaccines:

¹  Use when patient did not get the first dose from your store; this will apply second dose admin fee
²  Use when patient did not get the second dose from your store; this will apply second dose admin fee
³  Created by FDS as a placeholder NDC to be used when submitting claims for the Moderna booster

When do I need to use the Reason for Service code?

Use this code to specifically reference to the payer which dose or booster you are administering to the patient.

Can I bill for uninsured COVID-19 vaccine claims?

Yes, but you must first be set up with Optum Pay to successfully bill. Next, send an email to medbill@fdsrx.com and request to add the COVID19 HRSA UNINSURED TESTING AND TREATMENT FUND as payer. (NOTE: Please do not call; we can respond faster to emails than phone calls.) The payer will be added and you will be sent further instructions to begin billing.

Additional Information on the COVID-19 HRSA Uninsured Program:

HRSA has contracted with the UnitedHealth Group to be the sole administrator of the Uninsured Program for COVID-19. Pharmacies must have a direct deposit/ACH account with Optum Pay to submit claims.

To receive payment via direct deposit, pharmacies must:

• Enroll as a provider participant
• Check patient eligibility
• Submit patient information
• Submit the claim

Claims will be processed through Availity with an additional $0.06-per-claim pass-through charge applied to the claim.

Once you create an Optum ID or sign in with your existing one, you will need to:

• Validate the facility's Taxpayer Identification Number (TIN)
• Set up Optum Pay Automated Clearing House (ACH)
• Add Provider roster
• Add and attest to patient
• Submit claims for reimbursement

* * * NOTE: DO NOT TRANSMIT CLAIMS UNTIL YOU HAVE REGISTERED * * *

Find more information about HRSA guidance by visiting https://www.hrsa.gov/coviduninsuredclaim or https://coviduninsuredclaim.linkhealth.com/

Vital Data: