COVID Vaccine Billing Issue Report

COVID Vaccine Billing Issue Report
Please note:

Submitters should not expect their individual issues to be resolved from submitting them here. Submissions will be used to identify broad systemic issues with the billing of COVID vaccines.
Name of Submitting Person *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Pharmacy Name *
City *
State *
Name of payer for the issue in this report (PBM, insurance company) *
Benefit Type *

Medical Benefit Prescription Benefit
Name of intermediary used to bill medical benefit

Change Healthcare Electronic Billing Services (EBS) FDS OmniSYS TransactRx None Other
What PBM was the claim submitted to?

Is your pharmacy IN or OUT of network for this payer? *

In Network Out of Network Don't know
Which vaccine is involved with this claim? *

Moderna Pfizer Janssen (J&J) Other
Which dose was this claim for? *

First of two doses Second of two doses Single dose
What issue(s) did you have with billing this claim with this payer? (check all that apply) *

Claim Rejected Administration fee well below Medicare rates PBM paid an unexpected amount (e.g. $0.01) Claim shows a non-zero patient copayment Missing/Invalid prescriber ID when using Pharmacist NPI Other prescriber issue Patient not eligible Told to bill the claim elsewhere Told that the patient needs to go elsewhere to get vaccine Issue with correct recognition of first/second dose Was incorrectly rejected as a duplicate claim Other
Please briefly describe the prescriber issue.
Please provide any other information you feel is relevant to this issue (Do NOT included any PHI or payment rates).
Should be Empty:

Please note: