Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice Issued 07/17/2017

Pharmacy Influenza Vaccine Administration Fee - Billing Instructions Update

 

Date:  July 17, 2017                       

To:  Participating Pharmacies

Re:  Pharmacy Influenza Vaccine Administration Fee - Billing Instructions Update 

____________________________________________________________________________________

This notice provides clarification for pharmacies billing administration fees for the influenza vaccine. These changes were effective with the implementation of the Pharmacy Benefit Management System (PBMS) on March 26, 2017. The influenza vaccine is the only vaccine for which the Department pays an administration fee to the pharmacy.

Effective March 26, 2017, the Department no longer accepts the NCPDP S1 transaction for the vaccine administration fee. Both the cost of the vaccine and the administration fee should now be combined in the B1 transaction.

In order to receive the vaccine administration fee, pharmacies should enter the administration fee amount in the Incentive Amount Submitted field (438-E3). If the value in this field exceeds $6.40, the maximum allowed by the Department, the claim will reject. If the value of the field is less than or equal to the Department allowed amount, the system will pay the lesser of the two. The value ‘MA’ must be entered in the Professional Service Code field (440-E5). The claim will reject if a claim is submitted with an incorrect value in one of these fields.  If a claim is submitted with a National Drug Code (NDC) for an influenza vaccine, but neither of these fields is populated, no administration fee will be paid.

Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Felicia F. Norwood

Director