ATTENTION PRUITTHEALTH PREMIER HEALTH PLAN PROVIDERS:
The Centers for Medicare and Medicaid Services (CMS) guidance for submitting COVID-19 vaccination claims for Medicare Advantage plan members to Original Medicare will be ending effective December 31, 2021. Beginning January 1, 2022, all Medicare Advantage Organizations are to pay for the COVID-19 vaccine and its administration without cost sharing.
What This Means for You:
Claims for COVID-19 vaccinations or booster injections administered to PruittHealth Premier members on or after January 1, 2022, should be submitted directly to PruittHealth Premier.
COVID-19 Vaccine Reminders:
Patients may receive the COVID-19 vaccine, including additional and booster doses, without a physician’s order or supervision. They pay nothing for the COVID-19 vaccine or its administration.
If you participate in the CDC COVID-19 vaccination program you must:
- Administer the COVID-19 vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
- Vaccinate everyone, including the uninsured, regardless of coverage or network status.
You Should Not:
- Balance bill for COVID-19 vaccinations
- Charge your patients for an office visit or other fee if COVID-19 vaccination is the only medical service given.
- Require additional medical or other services during the visit as a condition for getting COVID-19 vaccination.
For additional information regarding the latest from CMS regarding COVID-19 vaccination, please visit this site: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
For information regarding CMS guidance regarding billing, please visit this site: https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration
If you have any questions, please contact the Provider Services number:
- 1-855-855-0668 (TTY 711) for Georgia
- 1-855-855-0759 (TTY 711) for North Carolina and South Carolina
Thank you for being a valued partner.