COVID Vaccine, Therapeutics & OTC Test Billing Issue Report

COVID Vaccine, Therapeutics & OTC Test 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 and therapeutics.
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 Medicare Part B
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 product is involved with this claim? *

Moderna Vaccine Pfizer Vaccine Janssen (J&J) Vaccine REGEN-COV Paxlovid (Pfizer) Molnupiravir (Merck) OTC COVID Test Other
Which dose was this claim for? (For OTC Test, select Other, specify which test) *

First of two doses Second of two doses Single dose Third mRNA dose (immunocompromised patient) Booster mRNA dose Monoclonal Antibodies initial or repeat Antiviral Course of Therapy Other
What issue(s) did you have with billing this claim with this payer? (check all that apply) *

Claim Rejected PBM paid an unexpected amount Claim shows a non-zero patient copayment Patient not eligible Told to bill the claim elsewhere Told that the patient needs to go elsewhere to get vaccine, monoclonal antibodies or antiviral Issue with correct recognition of first/second/third/booster dose Not in-network for OTC Test billing OTC Test non-preferred NDC, use a different product Other
Please briefly describe the prescriber issue.
Please provide any other information you feel is relevant to this issue (Do NOT included any PHI).
Should be Empty:

Please note: