Healthcare providers, pharmacies, and mass immunizers can now recoup administration costs for COVID-19 vaccines given to underinsured patients whose plans do not cover administrative costs or that require some sort of cost-sharing, according to a May 3rd announcement by the Department of Health and Human Services (HHS). Vaccine providers are still not permitted to bill patients directly but can submit claims using the Health Resources and Services Administration’s (HRSA) COVID-19 Coverage Assistance Fund (CAF).
Some health plans are not subject to the CARES Act, which requires non-grandfathered group health plans and issuers offering non-grandfathered group or individual health insurance coverage to cover any qualifying coronavirus preventive service with no cost-sharing for members. But some health plans are exempt from this requirement. For front-line providers offering the vaccine, this presents an unexpected cost burden, which the CAF addresses.
HRSA will reimburse eligible providers at the national Medicare rate for administering the COVID-19 vaccine, while CAF funding is available. Vaccine providers can submit claims directly through the CAF portal once they register. According to the portal site, it will take 3-4 days to process the registration before claims can be submitted.
What Claims Can Be Submitted?
Vaccine providers can submit claims only when:
- They receive (or received) a denial from the patient’s insurance company
- The patient’s health plan requires the patient to pay a portion of the cost.
When submitting a claim, the provider must agree to all terms and conditions. Providers who submit claims using the CAF portal could be subject to a post-reimbursement audit review. Providers submitting claims through CAF must attest to the following:
- They submitted a claim for vaccine administration to the patient’s health plan and received verification that the claim was denied or required patient cost-sharing.
- They verified that no other payer will reimburse them for the vaccine administration costs.
- They accept the CAF reimbursement in full.
- They agree not to balance bill the patient.
What is the Reimbursement Rate?
Reimbursement is based on national Medicare rates for administering the COVID-19 vaccine and the date the vaccine was administered. Rates are not geographically adjusted.
Vaccines Provided through March 14, 2021
Vaccines administered on or before March 14, 2021 are reimbursed at the following rates:
|Single Dose COVID-19 Vaccine Administration||First Dose of 2-Dose Vaccine Administration||Second Dose of 2-Does Vaccine Administration|
Vaccines Administered on of after March 15
For vaccines given on or after March 15, 2021, the administration rate is $40 per dose.
How Do I Enroll in the CAF?
You must create an account using the Coverage Assistance Fund portal. Once enrolled, eligible vaccine providers can submit claims through their current clearinghouse or submit a claim electronically or manually through the Portal.
What About Uninsured Patients?
If you vaccinated uninsured patients on or after December 14, 2020, you can submit claims for reimbursement to the HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured.
American Exchange Can Process Your COVID-19 Claims
American Exchange is helping state and local health departments across the country with their vaccine administration billing needs. Our certified coders and billing experts can rid you of your vaccine billing backlogs and submit denied claims meeting the requirements identified above to CAF for reimbursement. For a county health department, we cleared a backlog of more than 40,000 cases in four months, billing for more than $2 million in reimbursement. Let us help you get reimbursed for the services you rendered so you can serve even more community members in need.