October 5, 2019

State of Alabama
Press Release: Medicaid

Changes to Pharmacy Vaccine Administration Billing


TO:  All Pharmacy Providers

 

PDF Version


Effective October 15, 2019, Alabama Medicaid will change how Medicaid-enrolled pharmacy providers submit claims for vaccine administration for eligible recipients age 19 and older. Claims for a vaccine and the administration of the vaccine will be submitted on the same claim. 

 

Instructions for submitting a pharmacy claim for a vaccine with the administration fee:

 

           Pharmacies should submit a claim for the vaccine (i.e. ingredient) with the appropriate NDC.

 

       Pharmacies should submit the administration fee in the Incentive Amount Submitted field

(NCPDP Field 438-E3) on the same claim as the vaccine (i.e. ingredient).

 

       A maximum reimbursement of $5 will be allowed for each vaccine administration. Only one dispensing fee (for the ingredient) and copay will be applied to the claim.

 

           Reimbursement of administration fees will be allowed for the following vaccines:

 

o    influenza vaccine

o    pneumococcal vaccine

o    Tdap vaccine

o    hepatitis A vaccine

 

       A prescription is required for each vaccine and administration to be retained on file for documentation purposes.

 

           Claims for the administration fee only with no vaccine/ingredient will be denied. 

 

       To facilitate coordination of care, Pharmacy providers are required to inform (via phone, fax, e-mail, or mail) each recipient’s Primary Medical Provider (PMP) upon administration of the vaccine(s) for which an administration claim is submitted. Documentation of the notification to the PMP must be kept on file at the pharmacy. If the PMP is unknown, the pharmacy may call the Alabama Medicaid Automated Voice Response System (AVRS) at 1-800-727-7848 to obtain the PMP information. A suggested Immunization Provider Notification Letter, which can be used to notify the PMP, can be found on the Agency website at https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Services/9.4.13_PH_Immunization_Provider_Notification_Letter_2-1-19.pdf.

 

       Alabama State Board of Pharmacy law and regulation should be followed regarding dispensing and administration of legend drugs/vaccines.

 

      For additional questions regarding this ALERT, please contact Pharmacy Services at (334) 242-5050.





  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here