12/22/2020 - COVID Vaccine: Mock NDC's
EBS has created mock NDC codes that you can add to your pharmacy system. By using these mock NDC codes, we will be able to auto create the claim for the administration fee. For example...if you submit NDC 00000913001 EBS will bill the Pfizer-Biontech AND the first dose vaccine administration codes automatically for you. As a reminder, you will not be paid for the vaccine (although it has to be billed with the administration fee code). We will be billing the drug at $0.01 and the administration rates will be billed based upon the reimbursement rates of $16.94 for the first vaccine and $28.39 for the second vaccine.
Here are the NDC codes to use:
00000913001 COVID Pfizer-Biontech First Vaccine
00000913002 COVID PfizerBiontech Second Vaccine
00000913011 COVID Moderna First Vaccine
00000913012 COVID Moderna Second Vaccine
00000913021 COVID AstraZeneca First Vaccine
00000913022 COVID AstraZeneca Second Vaccine
Every claim is expected to pay at 100% of the allowed amount regardless of the payer. Providers can submit the claims via your pharmacy management system by using our BIN 610160 (which tells your switch that EBS is processing your claims) and the appropriate PCN (which tells EBS what payer you are asking for us to bill). The PCN list is attached to this email. I will warn you....we bill to LOTS of payers....so this list can feel overwhelming. Let me help you break it down:
Medicare and Medicare Advantage claims should be submitted using BIN 610160 and the PCN for "Medicare-[your state]" (see attached list)
Medicaid and Medicaid MCO's should be submitted using BIN 610160 and the PCN for "Medicaid-[your state]" (see attached list)
Commercial plans should be submitted using BIN 610160 and the PCN for the insurance payer name on the attached list. If the plan is listed multiple times...just pick the one that matched your plan the closest. If you need assistance, please contact our our office at 573-472-3613 and then dial by department to reach our claims department or the management team. We are happy to assist you!
Claims for patients that have NO insurance should be submitted using BIN 610160 and the PCN of EBS33926. We will file these claims to HRSA using the login and password that you would have supplied to EBS.
If you have not enrolled for HRSA for uninsured patients, please do so by going to ebsservice.com and click on Resources. You will then scroll down to the black header that says "COVID Vaccines", then click on the second link. You will have to set up an Optum ID account username and password. Once you have this information, please email your username and password to firstname.lastname@example.org. We will be using your login credentials for submitting and reconciling your claims.