The Alabama Medicaid Agency, in conjunction with the Alabama Department of Public Health (ADPH), has stated it will allow reimbursement of a vaccine administration fee to Alabama Medicaid pharmacy providers who utilize free influenza vaccines provided by the federal government. The following guidelines have been provided for administering the free vaccines to Alabama Medicaid patients.
- Providers must use all privately purchased vaccines first.
- Free supplemental influenza vaccine costs cannot be reimbursed, but an administrative fee can be requested.
- When billing a Medicaid recipient for the free vaccine, no ingredient cost or dispensing fee should be included on the claim.
- A $5.00 administration fee may be submitted.
- Pharmacies should submit the administration fee in the Incentive Amount Submitted field (NCPDP Field 438-E3) on the same claim as the vaccine (i.e. ingredient).
- Recoupments may occur if it is determined that a free supplemental vaccine was administered to a Medicaid patient and an ingredient cost and dispensing fee were submitted on the claim.
- All administered vaccines must be entered into ImmPrint via an interface or manually within 72 hours.
- For more information, visit the ADPH guidance here: https://www.alabamapublichealth.gov/immunization/assets/fluvaccine_adult.pdf
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.