Agencies
Services
Provider Notice issued 10/09/09
To: Participating Pharmacy
Date: October 9, 2009
Re: Reimbursement for the H1N1 Vaccination
Effective October 7, 2009, the Department of Healthcare and Family Services will begin reimbursing participating pharmacies for the administration of the H1N1 vaccines to enrolled HFS clients. The Department’s maximum allowable reimbursement for administration of the H1N1 vaccine shall be $6.40.
To receive reimbursement for H1N1 vaccine administration, pharmacies must bill for both the vaccine NDC and the administration fee on the same claim. However, HFS will reimburse pharmacies only for the vaccination administration fee, as vaccine acquisition costs are fully subsidized by the U.S. Centers for Disease Control and Prevention. The administration fee should be submitted in the NCPDP 5.1 Pricing Segment, Professional Service Fee Submitted (477-BE) field. HFS will return administration fee payment information to the pharmacy in the Professional Service Fee Paid (562-J1) field on the NCPDP Response Pricing Segment.
For additional information on the clinical considerations and recommendations for H1N1 flu, please use the following links:
http://www.cdc.gov/h1n1flu/
http://www.flu.gov/
http://www.idph.state.il.us/h1n1_flu/index.htm
http://www.cdc.gov/flu/swineflu/key_facts.htm
Questions regarding this notice should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, Option 7.
Theresa A. Eagleson, Administrator
Division of Medical Programs