Covid Vaccine Payment for out of network insurance

We have been administering Covid vaccine to people who meet criteria per CDPH and CDC.

I am surprised to learn that some teachers who have PPO insurance received the Covid vaccine elsewhere and only their coworkers who have Medicaid and HMO are coming to my office for Covid vaccines.

Is there something in writing that states that regardless of whether I am in network the Covid vaccine administration will be covered at my office?

I just received the temporary authorization to bill Medicare and wonder if I also have to enroll “temporarily” in all the Medicaid and HMOs in order to receive the minimal payment for vaccine administration from the insurance companies.

Thank you

We are registered with our state (Pennsylvania) to receive the Covid vaccine but have yet to be given any. I’m curious about your temporary authorization to bill Medicare. Can you share more information about that?

I applied to Medicare exclusively for Covid vaccine.
We tried on the CMS home page but the link to Covid 19 vaccine said page was not found. After spending an hour on the phone, I was told I will receive an email.

Within a couple of days I received an email from:

NGSPECommunications@anthem.comYou might want to send an email to the above email address, they might answer your email so that you don’t waste your time on the phone.

I applied in January, Now it’s 3 months later, they might have improved their system since more providers are administering the vaccine.

Nava Segall, MD FAAP
4116 N. Lincoln Avenue
Chicago, IL 60618
Phone: 773-883-2350
email: chicagomedicaloffice@gmail.com

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Good morning! We have not applied to receive the COVID vaccine for in office administration yet. We are able to via IMMUNET (Maryland) through which we order VFC vaccines. Are you billing the patient’s insurance (weather commercial or medicaid) for the administration fee. If not, what is the MEDICARE billing process as our practice and patient are not “MEDICARE” members/providers. What then is the work-flows in your EMR system for billing these new administration codes? Thanks in advance!

We are not Medicare providers and I was able to get a temporary id last week. I called last Wednesday afternoon, spent about 15-20 minutes on the phone with them and had our temporary id the next morning. You will want to tell them that you are requesting to get your practice credentialed as a mass vaccinator and they will just need a few details from you. Here is the most recent information listed on Medicare’s website about the process.

I’m Not Currently Enrolled as a Medicare Provider

If you’re not a Medicare provider, you must qualify and enroll as a mass immunizer or other Medicare provider type that allows billing for administering vaccines. Enrolling over the phone is easy and quick — call your Medicare Administrative Contractor (MAC)-specific enrollment hotline (PDF) and give them your:

  • Valid Legal Business Name (LBN)
  • National Provider Identifier (NPI)
  • Tax Identification Number (TIN)
  • Practice location
  • State license, if applicable

Cathy

Cathy Homick
Hilliard, OH

With gratitude!

We are submitting the vac admin code to the insurance if they are insured. There is a Covid fund for uninsured.
So far, after 3 months, we have not received payments for uninsured patients.
Some medicaid MCO rejected the claim.
Some BCBS HMO rejected stating that I am not authorized to provide the services.
Some insurance plans that I never heard of before sent an EOB with $0 without any explanation. (Bright Health is one of them).
We are waiting to see if Medicare would pay.

Just a follow-up to the Medicare insurance billing…

How are you billing your claims? We are EMR based through which we bill all insurance claims. Are we needing “medicare” id numbers for our pediatric patients for billing the vaccine admin codes? Is your billing process "OUTSIDE’ of your EMR (ie, printing HCFA 1500s and mailing, uploading to a designated “MEDICARE” billing site manually, etc.)?

Thanks!

I believe we submit the majority of the claims via the EMR.
The exception may be for uninsured patients.
You need a roster, contact the uninsured fund which provides an ID and hopefully someday will pay something for the vaccine administration.
Get the medicare number.

I’ll check with the billing service.