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
NONE
Other
What PBM was the claim submitted to?
Claim submission details
BIN #
PCN #
Group #
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
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 that the patient needs to go elsewhere
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).
Submit
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