January 2022
For the 2021-2022 influenza season, Neighborhood will now require pharmacies to use Rhode Island state-supplied vaccines for influenza immunizations for Medicaid and Commercial Members.
How to bill for state-supplied vaccines
- Submit Professional Code: MA
- Place Coordination of Benefits or CB Code: 15
- Bill for zero ($0.00) ingredient cost
- The pharmacy will be reimbursed for the administration of the vaccine.
How to bill if utilizing pharmacy-purchased vaccines due to NO availability of state-supplied vaccine
- Submit Professional code: MA
- The claim will reject “If No State Supplied Vaccine Available; call 800-364-6331”
- Call the CVS Pharmacy Help Desk (800-364-6331) and an override will be provided.
- Pharmacy will be reimbursed for the vaccine product and administration of the vaccine.
Incorrect billing of state-supplied vaccine will yield rejections such as:
- “Covered under medical plan only,” if professional code and CB code not submitted. Claim must be submitted with the following:
- Submit Professional Code: MA
- Place Coordination of Benefits or CB Code: 15
- “$0 ingredient cost required for free product,” if ingredient cost is not zeroed. Claim must be submitted with the following:
- Submit with zero dollar ($0.00) ingredient cost