Providers will be able to bill and be paid for vaccine administration provided to enrollees of health plans that either do not cover vaccine administration or apply patient cost-sharing. Most state regulated insurers are required to cover the service without cost-sharing but self-funded plans do not have the same requirement. HRSA set up a new portal for such services retroactive to December 14, 2020. The payment amount will be based on the Medicare allowable in effect for the date of service ($16.94 or $28.39 through March 14 and $40 for vaccines administered March 15 and later). More information is available here.
Payment for vaccine administration and other COVID-19 services provided to uninsured individuals is paid through a separate portal and fund. More information is available here. (Andrew Busz, AndrewB@wsha.org)