Billing Vaccines and Flu Shots

Transmitting insurance claims for flu shots and vaccines in QuickSCRIP is similar to billing for other medications. You need to make sure the drug is setup correctly, and some insurances require certain DUR overrides.

Drug Setup

You'll need to set the vaccine up in your Drug Database before you can bill it.

In the Rx Processing Menu, chose Option 11 to go to the Drug File Maintenance screen. Verify that the drug is in there, and make sure it has the most up-to-date NDC number.

You will also want to verify Lines 6, 7, and 8 to make sure you are billing the correct quantity.

• Line 6. Pkg Qty is the package quantity of the drug as you received it from the

drug wholesaler. Vaccines are often shipped in packages of 5.

• Line 7. UNit type. Vaccines and shots are typically billed as EA (each), as they

are dispensed in single dispensing. In some rare instances, the insurance company wants to know the exact metric quantity of the active ingredient. For those instances you can use MG (milligrams), which will allow you to use very fine values in the Metric Multiplier line.

• Line 8 Metric Multiplier is the conversion factor for determining the metric units to be billed. A typical vaccine or shot has

0.5 for the metric multiplier.

SIG Commands

Some insurances require additional fields be sent when billing for flu shots. These values can be sent by entering the appropriate code in the SIG lines of the scrip prior to transmission. The two most common are:

• /DUIMA transmits the middle portion of the DUR (440-E5) override with MA.
• /ADMFEEtransmits the Administration fee to the insurance. If you wanted to bill an admin fee of $20.00

you would enter the SIG as /ADMFEE20.00. Please pay careful attention to the transaction response, as some insurances do not pay an administration fee, even if the value is sent.