Bulletin


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Bulletin Rate Correction - Gateway Health Plan Vaccine Administration Communication #84MG12 Commercial BIN: 012353 PCN: 03740000 Medicare BIN: 600428 PCN: 02710000 Date: September 19, 2012 Summary •

This bulletin is to announce the 2012/2013 implementation and the submission requirements for the new Gateway Health Plan vaccine administration for flu vaccines.

What You Need to Know • • • •

Gateway Vaccines will process through the ANA-109 network. Professional service code/intervention codes are required on the claim submission. The claims will be reimbursed as a Flat Fee. The members will have a $0 copay.

Eligible Drugs: GCN

Drug Name

32694

Fluzone Pedi 20122013 Syringe Fluzone 2012-2013 Vial Fluzone 2012-2013 Syringe Flulaval 2012-2013 Vial Fluarix 2012-2013 Fluvirin 2012-2013 Syringe Afluria 2012-2013 Syringe

32695 32698 32769 32774 32776 32777

ANA-109 rate Medicare and Medicaid $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00

©2012 by Argus Health Systems, Inc. All Rights Reserved. The computer systems, procedures, databases, software programs, documentation and other materials (collectively "Information") created, maintained or provided by Argus Health Systems, Inc. ("Argus"), are proprietary to Argus and are confidential. 84MG12

32778 32783

Fluvirin 2012-2013 Vial Afluria 2012-2013 Vial

$25.00 $25.00

Action Required There are several fields that must be completed on submitted claims in order to ensure payment. Pharmacies must complete the following mandatory fields: •

439-E4 - Reason for Service Code Pharmacy must submit a code of PH – Preventative Healthcare Code of indicating that the pharmacist is certified to provide the service.



440-E5 – Professional Service Code Pharmacy must submit a code of MA – Medication Administration in this field to indicate an action of supplying the vaccine.



441-E6 – Result of Service Code Pharmacy must submit a code of 3N – Medication Administered to reflect cognitive service and to indicate they have provided MCIR reporting to the state.

Claims that do not contain the above codes may reject. The pharmacy will receive an E5 M/I PROFESSIONAL SERVICE CODE NCPDP rejection code. For assistance processing claims, please call the Argus Pharmacy Help Desk at 800221-9537 for Medicare Part D, or 800-220-4532 for Medicaid.

©2012 by Argus Health Systems, Inc. All Rights Reserved. The computer systems procedures, databases, software programs, documentation and other materials (collectively "Information") created, maintained or provided by Argus Health Systems, Inc. ("Argus"), are proprietary to Argus and are confidential. 84MG12

Argus bulletin – 2012

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