August 20, 2021
While the federal government has purchased hundreds of millions of doses of the COVID-19 vaccine and is providing those at no cost, vaccinating providers are still able to be reimbursed for administering the vaccine. While physicians who participate in the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program contractually agree not to seek reimbursement from patients, health plans and insurers are required to reimburse for COVID-19 vaccine administration regardless of whether the services are provided by an in or out of network provider. For uninsured patients, providers can be reimbursed through the U.S. Department of Health and Human Services’ Provider Relief Fund.
However, the California Medical Association (CMA) has heard from some physicians about challenges with reimbursement for vaccine administration services. If your practice is experiencing challenges with COVID-19 vaccine administration reimbursement, CMA can help.
Providers should be aware, however, there are some nuances to successfully submitting claims for COVID-19 vaccine administration services that differ from the normal claim submission process. For example, Blue Shield has assumed all financial responsibility of payment for COVID-19 vaccine administration services. For Blue Shield HMO patients, this means that rather than billing the delegated group, practices should bill Blue Shield directly COVID-19 vaccine administration services. All other vaccines will continue to be billed to the delegated groups. For more information click here.
Also, Medi-Cal managed care claims must be submitted to Medi-Cal fee-for-service (FFS) rather than the Medi-Cal managed care plans for reimbursement. Additionally, Medicare Advantage claims must be submitted directly to Noridian, the Medicare FFS Administrative Contractor in order to be paid.
The California Medical Association (CMA) has published several resources including CMA’s COVID-19 Vaccine Reimbursement Quick Guide and COVID-19 Vaccine Toolkit for Physician Practices to provide answers to frequently asked physician questions about the COVID-19 vaccine rollout and billing guidance on administration of the vaccine. Both resources are updated frequently with the latest information regarding COVID-19 Vaccines.
If your practice has questions regarding COVID-19 vaccine billing or is experiencing reimbursement challenges, please contact CMA at EconomicServices@cmadocs.org or at (888) 401-5911.