Vaccine Information

How to Bill for Administration of Covered Part D Vaccines

• Physician purchases, administers and bills the member for both the vaccine cost and its administration. In order for a member to be reimbursed, the Vaccine Claim Form must be completed, signed by the provider and given to the member for submission to our Pharmacy Benefit Manager (Envision).
• Physician purchases, administers and bills our Pharmacy Benefit Manager (Envision) for both the vaccine cost and its administration. In order for the Physician to be reimbursed, the Vaccine Claim Form for physicians must be completed, signed and submitted to our Pharmacy Benefit Manager (Envision). Provider must collect applicable formulary co-pay from the member.
• Physician writes the prescription for the vaccine, which member gets filled at a network pharmacy and brings back to the physician's office for administration. In order for the provider to be reimbursed for the administration of the vaccine, the Vaccine Claim Form for physicians must be completed, signed, and submitted to our Pharmacy Benefit Manager (Envision). There is no member formulary co-pay to be collected, as the pharmacy has already collected this amount when the prescription was dispensed.
• Physician writes the prescription for the vaccine which is filled and administered by the pharmacist (where allowed by law). The pharmacist adjudicates the claim online and collects the applicable member co-pay. There are no further requirements for the Physician.

Click here to view information regarding Part B vs. Part D vaccines.

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