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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/15/07

Administration of Flu Vaccine

 

To:​

Enrolled Long Term Care (NF, ICF/DD and SLF) and Pharmacy Providers​
Date:​ November 15, 2007​
Re:​

Administration of Flu Vaccine​

 

 

 

The Department of Healthcare and Family Services (HFS) will reimburse pharmacies for the administration of influenza vaccine to adults age 21 and over beginning with the 2007-2008 influenza season.  For children through age 20, flu vaccine is covered under the Vaccines for Children (VFC) Program.  For dual eligible individuals, pharmacies must bill Medicare for influenza vaccine.

 

 

Pharmacies should submit both the vaccine and the administration fee on the same claim.  An administration fee cannot be billed on a separate claim that does not contain the influenza vaccine.  The administration fee should be submitted in the NCPDP 5.1 Pricing Segment, Professional Service Fee Submitted (477-BE) field.  The HFS claims processing system will return the administration fee payment information to the pharmacy in the Professional Service Fee Paid (562-J1) field on the NCPDP 5.1 Response Pricing segment.  The administration fee will also be included in the Total Amount Paid (509-F9) field.

 

The pharmacy must enter their usual charge for the administration of the vaccine.  The Department’s maximum allowable reimbursement for the administration of influenza vaccine is $3.70.

Any questions regarding this notice may be directed to the Bureau of Pharmacy Services at 877-782-5565, Option 7.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs