COVID-19 VACCINE BILLING FAQ

Frequently asked questions about billing for COVID-19 vaccines

COVID-19 Vaccine Billing FAQ Webinar 

w/ Medical Billing Product Manager Tim Wickis

Join product manager Tim Wickis for a 30-minute on-demand webinar designed to help you through the most common issues clients face when using FDS Amplicare's medical billing platform. No registration necessary; simply click below to watch.

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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:

Service HCPCS/CPT Admin Fee HCPCS Requires Reason for Service Code Supplier NDC
91300 0001A - 1st Dose   Pfizer 59267100001
59267100002
59267100003
0002A - 2nd Dose 1DF
0003A - 3rd Dose 2TD
0004A - Booster LD
91301 0011A - 1st Dose   Moderna 80777027310
80777027398
80777027399
0012A - 2nd Dose 1DF
0013A - 3rd Dose 2TD
91303 0031A   Janssen 59676058015
59676058005
0034A LD
91305 0051A - 1st Dose   Pfizer 59267102501
59267102502
59267102503
59267102504
0052A - 2nd Dose 1DF
0053A - 3rd Dose 2TD
0054A - Booster LD
91306 0064A - Booster LD Moderna 300000091306

 

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:

Payor # 95964
PCN COVIMS
BIN 007895
Group # N/A
ID # Temporary ID supplied by HRSA
MDQ 1 (for 1 shot given; not vaccine volume)

 

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