HHSC is preparing the fee-for-service pharmacy claim adjudication system to comply with the guidance of the National Council for Prescription Drug Programs for administering additional COVID-19 vaccine doses. The fee-for-service pharmacy adjudication system changes will be ready September 29, 2021, to allow the submission of vaccine claims with dates of service beginning August 12, 2021.
Pharmacies should submit an additional dose, whether determined to be a booster for the general population or additional doses for a target population, with the “Submission Clarification Code” (SCC) field (420-DK) value of “07” (medically necessary).
To assist pharmacies, HHSC updated:
- COVID-19 Vaccine Quick Reference (PDF), to download and make it available to your staff
- Medicaid B1 Payer Sheets (PDF)
Contact the HHSC Pharmacy Benefit Access Help Desk at 800-435-4165 with questions about fee-for-service pharmacy claims submission.
MCOs will provide instructions for COVID-19 vaccine claim billing through managed care.