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Pharmacy Procedure For COVID-19 Vaccine

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Memo
Effective Date:

To:
All Medicaid Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

Effective immediately, the Virginia Department of Medical Assistance Services (DMAS) will reimburse pharmacy providers for coronavirus disease 2019 (COVID-19) vaccinations. This policy includes pharmacist-ordered COVID-19 vaccines administered by qualified pharmacists or pharmacist-supervised pharmacy interns or technicians. Vaccinations can be administered to all eligible Virginia Medicaid members meeting criteria for the Vaccine Emergency Use Authorization (EUA) (https://www.hhs.gov/about/news/2020/12/11/statement-hhs-dod-on-fda-emergency-use-authorization-covid-19-vaccine-candidate.html). See the Health and Human Services (HHS) Guidance regarding Public Readiness and Emergency Preparedness (PREP) Act Coverage (https://www.phe.gov/Preparedness/legal/prepact/Pages/default.aspx). 

Pharmacies must bill the Point of Sale (POS) National Council for Prescription Drug Programs (NCPDP) codes. Pharmacies will NOT be paid dispensing fees for vaccines but will be reimbursed for vaccine administration fees according to Medicare established rates.

NOTE: Immunizations for Dual Medicare and Medicaid members (DUALS) must be billed to Medicare.

Reminders: Pharmacy providers administering COVID-19 vaccinations should communicate the following to Medicaid members receiving the Pfizer or Moderna COVID-19 vaccines (both of which require two doses to complete the series):

  • It is preferred that the person receive their second dose of vaccine at the location they received their first dose.
  • Administration of the second dose may occur within a 4-day grace period (between days 17-21 for the Pfizer vaccine or days 24-28 for the Moderna vaccine).  If vaccine administration occurs after these recommended time periods, please immunize at the earliest opportunity. 

Pharmacists are also encouraged to remind their patients that Medicaid covers transportation to medical services under most benefit programs. Members (or providers on behalf of members) who require transportation assistance for their vaccinations, can schedule transportation by calling the appropriate number on this contact list: https://www.dmas.virginia.gov/files/links/432/DMAS%20-%20All%20Programs%20-%20Transportation%20Contact%20List%2007-22-2020.pdf

Notice of Medicaid MCO Coverage of COVID-19 Vaccine Administration

All DMAS Managed Care Organizations (MCOs) will cover the COVID-19 vaccine at no charge to their members. Please check with each MCO for claim submission specifications.

CONTACT NUMBERS

AETNA BETTER HEALTH of VIRGINA

Member services

CCC Plus: 1-855-652-8249

Medallion/FAMIS: 1-800-279-1878

Pharmacy Help Desk

CCC Plus: 1-866-386-7882

Medallion/FAMIS: 1-855-270-2365

ANTHEM

Medallion 4

Anthem Member Services - 800-901-0020

Anthem Provider Services - 800-901-0020

Ingenio Rx for Pharmacists- 833-253-4452

Ingenio Rx for Members -    833-207-3120

CCC Plus

Anthem Member Services - 855-323-4687

Anthem Provider Services - 855-323-4687

Ingenio Rx for Pharmacists- 833-253-4452

Ingenio Rx for Members -    833-207-3120

MAGELLAN  COMPLETE CARE

CCC Plus Member Services and PBM - 1-800-424-4524

Medallion 4 Member Services and PBM - 1-800-424-4518

OPTIMA

CCC+ and Medallion Member services: 844-724-5576

CCC+ and Medallion PBM’s help desk: 888-946-1167

UNITED HEALTH CARE

United CCC Plus

Member Services          866-622-7982

Provider Services          877-843-4366

Pharmacy Help Desk    855-873-3493

United Medallion 4.0

Member Services          844-752-9434

Provider Services          844-284-0146

Pharmacy Help Desk    844-284-0149

VIRGINIA PREMIER

Phone number to PBM (Elixir) Medallion 4    1-855-872-0005

                                                   CCC Plus       1-844-838-0711

Virginia Premier Internal Pharmacy Department help desk = 1-855-813-0363

Notice of Medicaid FFS Coverage of COVID-19 Vaccine Administration

The purpose of this notice is to inform providers that DMAS fee-for-service will cover the two (2) new COVID-19 vaccines administered in pharmacies.

Effective December 28, 2020, claims can be submitted to Virginia Medicaid FFS for coverage of COVID-19 vaccine administration using NCPDP EMERGENCY PREPAREDNESS GUIDANCE – COVID-19 VACCINES.  Please refer to the link below and review the Claim Billing/Claim Re-bill Payer Sheet for specific VA FFS requirements. https://www.virginiamedicaidpharmacyservices.com/provider/external/medicaid/vamps/doc/en-us/VAMPS_Payer_Specification.pdf  

Summary of changes for COVID-19 Vaccines the following applies:

Field #

NCPDP Field Name

Value

Payer Usage

Payer Situation

42Ø-DK

SUBMISSION CLARIFICATION CODE

 

Qualified Requirement (RW)

NEW:  An Incentive Fee will be paid where Submission Clarification Code = 2 (initial dose) is submitted on the claim.

A Flat Incentive Fee will be paid where Submission Clarification Code = 6 (subsequent dose) is submitted on the claim.

438-E3

INCENTIVE AMOUNT SUBMITTED

 

RW

NEW: An Incentive Fee will be paid where Submission Clarification Code = 2 (initial dose) is submitted on the claim.

A Flat Incentive Fee will be paid where Submission Clarification Code = 6 (subsequent dose) is submitted on the claim.

423-DN

BASIS OF COST DETERMINATION

 

RW

NEW: Basis of Cost Determination ‘15’ (free product or no associated cost)

44Ø-E5

PROFESSIONAL SERVICE CODE

 

RW***

NEW: Professional Service Code ‘MA’ (Medication Administered) claims will deny if MA is not entered on the claim.

Changes to the DMAS pharmacy claim-processing system allow COVID-19 vaccination pharmacy claims ordered by pharmacists using their Collaborative Practice Agreements prescriber’s NPI and pharmacy’s National Provider Identifier (NPI) as the provider.  If the pharmacist uses their NPI as the prescriber, a service authorization is required from the Magellan Call Center.

If a pharmacy claim is submitted for a member’s second vaccination dose with a National Drug Code (NDC) for a vaccine from a different manufacturer than the manufacturer used with the first dose, the claim will be denied.

PHARMACY “Call Center”          

The Magellan pharmacy call center supports all pharmacy claims processing and is available to answer pharmacy questions 7 days a week 24 hours per day at 800-932-6648

*************************************************************************************

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

KEPRO

Service authorization information for fee-for-service members.

https://dmas.kepro.com/

 

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

 

 

Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

www.MagellanHealth.com/Provider

For credentialing and behavioral health service information, visit:

www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or

call: 1-800-424-4046

 

Provider HELPLINE

Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.

1-804-786-6273

1-800-552-8627

Aetna Better Health of Virginia

aetnabetterhealth.com/virginia

1-800-279-1878

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-800-901-0020

Magellan Complete Care of Virginia

www.MCCofVA.com

1-800-424-4518 (TTY 711) or 1-800-643-2273

Optima Family Care

1-800-881-2166

United Healthcare

Uhccommunityplan.com/VA and myuhc.com/communityplan

1-844-752-9434, TTY 711

 

Virginia Premier

1-800-727-7536 (TTY: 711)