TO: All
Pharmacy Providers
PDF Version
Effective October 15, 2019,
Alabama Medicaid will change how Medicaid-enrolled pharmacy providers submit
claims for vaccine administration for eligible recipients age 19 and older.
Claims for a vaccine and the administration of the vaccine will be submitted on
the same claim.
Instructions for submitting a pharmacy claim for a
vaccine with the administration fee:
•
Pharmacies
should submit a claim for the vaccine (i.e. ingredient) with the appropriate
NDC.
•
Pharmacies
should submit the administration fee in the Incentive Amount Submitted field
(NCPDP Field 438-E3) on the same
claim as the vaccine (i.e. ingredient).
•
A
maximum reimbursement of $5 will be allowed for each vaccine administration.
Only one dispensing fee (for the ingredient) and copay will be applied to the
claim.
•
Reimbursement
of administration fees will be allowed for the following vaccines:
o influenza vaccine
o pneumococcal vaccine
o Tdap vaccine
o hepatitis A vaccine
•
A
prescription is required for each vaccine and administration to be retained on
file for documentation purposes.
•
Claims
for the administration fee only with no vaccine/ingredient will be denied.
•
To
facilitate coordination of care, Pharmacy providers are required to inform (via
phone, fax, e-mail, or mail) each recipient’s Primary Medical Provider (PMP)
upon administration of the vaccine(s) for which an administration claim is
submitted. Documentation of the notification to the PMP must be kept on file at
the pharmacy. If the PMP is unknown, the pharmacy may call the Alabama Medicaid
Automated Voice Response System (AVRS) at 1-800-727-7848 to obtain the PMP
information. A suggested Immunization Provider Notification Letter, which can
be used to notify the PMP, can be found on the Agency website at https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Services/9.4.13_PH_Immunization_Provider_Notification_Letter_2-1-19.pdf.
•
Alabama
State Board of Pharmacy law and regulation should be followed regarding dispensing
and administration of legend drugs/vaccines.
• For additional
questions regarding this ALERT, please contact Pharmacy Services at (334)
242-5050.