Billing COVID: Difference between revisions

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==Setup the Vaccine==
==Setup the Vaccine==
You will need to create '''TWO''' versions of the Vaccine on your  '''Drug File Maint'''. This is because some insurances want to have $0.01 for the ingredient cost, but others want the normal cost. Sending the incorrect value will cause the ins to not reimburse properly.
You will need to create '''TWO''' versions of the Vaccine on your  '''Drug File Maint'''. This is because some insurances want a $25.00 cost per injection, while others want only $0.01 cost per injection. Sending the incorrect value will cause the insurance to not reimburse properly.


On the First Version of the vaccine, setup as you would any other drug (Name, NDC, Package Quantity, etc.) But with the following changes:
On the First Version of the vaccine, setup as you would any other drug (Name, NDC, Package Quantity, etc.) But with the following changes:
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[[File:COVID_drug_setup2.jpg|1000px|Example COVID Drug]]
[[File:COVID_drug_setup2.jpg|1000px|Example COVID Drug]]


If you are unsure which drug to bill, try the first one (with the $250 AWP) and see if the insurance bills correctly. If it does not, reverse and try the penny version.  
If you are unsure which drug to bill, try the first one (with the $250 AWP) and see if the insurance bills correctly. If it does not, reverse and try the penny version.


==Billing the Vaccine in the Fill Screen==
==Billing the Vaccine in the Fill Screen==

Revision as of 20:58, 11 January 2021

The following instructions are for setting up to bill insurances for the 2-dose COVID-19 vaccine. As of the creation of this guide, this info has only been tested on the MODERNA vaccine, not the PFIZER vaccine, but the same information should be applicable.

Insurances require that COVID Vaccines be billed with an AWP value of $0.01, but will pay an administration fee to cover the labor of dispensing the vaccine.

If you require assistance in setting up or billing a vaccine, please contact Cost Effective Computers, and an agent will assist you. An update may be required to ensure all the features discussed below work properly. It should require no more than 5 minutes to perform.

Setup a 1-cent Price Table

A special price table is required to correctly bill the vaccine.

  1. From the Rx Processing Menu select option 15 "Price Table Maint.
  2. Search for Table 99
  3. Hit Next or Previous a few times and take note of price table numbers, and look gaps in the sequence; these are unused tables. When you've found a number that is not used, write it down, as this will be the new table you create.
  4. Choose A to Add a new table. Assign it the number you chose from the previous step, and give it the description 1 Cent COVID
  5. Setup the following columns (or use the image provided below as a guide)
    1. Line 3: 999999.00
    2. Line 4: -99.99
    3. Line 5: 0.01

After adding the last value, press escape to skip to the bottom of the screen.

    1. Line 123 should be D
    2. Line 124 should be A
  1. E to Exit

Example Price Table

Setup the Vaccine

You will need to create TWO versions of the Vaccine on your Drug File Maint. This is because some insurances want a $25.00 cost per injection, while others want only $0.01 cost per injection. Sending the incorrect value will cause the insurance to not reimburse properly.

On the First Version of the vaccine, setup as you would any other drug (Name, NDC, Package Quantity, etc.) But with the following changes:

  • Set AWP and AQC to $250.00 (Calculates to $25.00 per shot)
  • Keep the default price table

Setup the Second Version of the vaccine with the following exceptions:

  • Give it a different name from the original, indicating that this vaccine bills only a penny for INGREDIENT COST. Example "Marixa 0.01"
  • Whatever the Package Quantity is on Line 6, set the AWP value on on Line 16 to be that many cents. (Example: if the quantity is 1, then set AWP to be $0.10)
  • Set line 5 Price Table to match the price table you setup in the previous section.
  • Set the following codes on Line 39, Price Codes (pick them from the menu options listed)
    • Disable Rounding Table
    • Use Drug U&C Price NOT 3pI Price
    • Exclude Drug from Minimum Price

Use the image provided below as a guide.

Example COVID Drug

If you are unsure which drug to bill, try the first one (with the $250 AWP) and see if the insurance bills correctly. If it does not, reverse and try the penny version.

Billing the Vaccine in the Fill Screen

Setup the prescription to bill an insurance as you would normally. Add the following commands to the SIG lines:

  • Submission Clarification Code: /XD02 for First Dose, or /XD06 for second dose
  • DUR Codes: /DUIMA (DUR codes may be different from insurance to insurance)
  • Administration Fee: /ADMFEE$20.00 (or however much you wish to bill for the admin fee)

COVID SIGs

Transmit the claim, see if it is accepted, and take note of how much of the administration fee the insurance pays. To help track customers who have been administered their first dose, you can use the Manual Refill Queue to set a reminder for the second dose one month later.