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COVID-19 Vaccine Administration by Pharmacies

Health Partners Plans (HPP) will follow policies related to coding and reimbursement issued by the Centers for Medicaid & Medicare Services (CMS) and the Pennsylvania Department of Human Services (DHS).

CVS/caremark, HPP’s contracted PBM, has implemented a process that will allow you to administer the vaccine at the point of sale and be reimbursed by CVS/caremark for that service. However, if for some reason you choose not to participate in that program or if you prefer to submit claims directly to Health Partners Plans (HPP) for reimbursement, we have adjusted our systems to allow for payment to non-participating HPP pharmacy providers.

Non-participating pharmacy providers may submit an 837 Professional (837P) claim or a CMS 1500 to HPP for the administration of the vaccines by the pharmacist. The billing and rendering provider for the administration fee claim should be the pharmacy’s National Provider Identifier (NPI). A prescriber NPI should be submitted in the referring provider field.

Note for Urgent Care Centers - Vaccine administration should not be billed as an urgent care visit. Urgent care centers will require a contract amendment for the vaccine administration codes and will receive additional communication.

Medicare Non-Par Providers
Medicaid & CHIP

$0

Provider is required
to bill CMS

$16.94*
(1st Dose)

$28.39*
(2nd Dose)

Health Partners (Medicaid) and Health Partners Medicare claims should be mailed to:

Health Partners Plans
P.O. Box 1220
Philadelphia, PA 19105-1220

For electronic claims, use payer ID #80142

 

KidzPartners (CHIP) claims should be mailed to:

KidzPartners
P.O. Box 1230
Philadelphia, PA 19105-1230

For electronic claims, use payer ID #80142

We appreciate your continued support in managing the needs of our members. If you have any questions, please contact our Pharmacy Services Helpline at 1-866-841-7659,Monday – Friday, 9 a.m. – 6 p.m.

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