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?
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 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).
Submit
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