Billing Vaccines and Flu Shots (2015-2016)

From QuickSCRIP Wiki
Jump to: navigation, search

Transmitting insurance claims for flu shots and vaccines in QuickSCRIP is similar to billing for other medications. You need to make sure the drug is setup correctly, and some insurances require certain DUR overrides.

If you wish to create a vaccine update fax for a doctor, click here.

Drug Setup

You'll need to set the vaccine up in your Drug Database before you can bill it.

In the Rx Processing Menu, chose Option 11 to go to the Drug File Maintenance screen. Verify that the drug is in there, and make sure it has the most up-to-date NDC number.

You will also want to verify lines 6, 7, and 8 to make sure you are billing the correct quantity.

  • Line 6. Pkg Qty is the package quantity of the drug as you received it from the drug wholesaler. Vaccines are often shipped in packages of 5.
  • Line 7. Unit type. Vaccines and shots are typically billed as EA (each), as they are dispensed in single dispensing. In some rare instances, the insurance company wants to know the exact metric quantity of the active ingredient. For those instances you can use MG (milligrams), which will allow you to use very fine values in the Metric Multiplier line.
  • Line 8 Metric Multiplier is the conversion factor for determining the metric units to be billed. A typical vaccine or shot has 0.5 for the metric multiplier.

In order to help QuickSCRIP track vaccine dispensing, you'll also want to mark the drug as a vaccine on Line 38: Code. Vaccine types are:

  • Flu Vaccine
  • Pneumonia Vaccine
  • Shingles Vaccine
  • Tetanus Vaccine
  • Other 1 (For tracking vaccines that don't fall into the above categories)
  • Other 2 (For tracking vaccines that don't fall into the above categories)

CPT Codes

Some insurances require a CPT code be sent for the vaccine. These can be attached to the vaccine in the Drug File Maint screen, on the Code Line (line 38). A menu will pop-up allowing you to choose CPT Code from a list, then QuickSCRIP will prompt you for the code.

SIG Commands

Some insurances require additional fields be sent when billing for flu shots. These values can be sent by entering the appropriate code in the SIG lines of the scrip prior to transmission. The two most common are:

  • /DUIMA transmits the middle portion of the DUR (440-E5) override with MA.
  • /ADMFEE transmits the Administration fee to the insurance. If you wanted to bill an admin fee of $20.00 you would enter the SIG as /ADMFEE$20.00. Please pay careful attention to the transaction response, as some insurances do not pay an administration fee, even if the value is sent.
  • /IC=xxx transmits Diagnosis code (where xxx is the diagnosis code). This is not required on all claims, but some insurances may require one.

Customer Records

In addition to billing and transmitting vaccines to insurances, QuickSCRIP can also track when a customer was last vaccinated. If a drug has been marked on the Code Line (Drug Screen, line 38), QuickSCRIP will log the date when the scrip is filled.

  1. Start in the Pharmacy Main Menu
  2. Choose Option 13 Patient File Maint.
  3. Search for a Patient.
  4. Type O4 (letter O) to go to screen 4.
  5. Lines 27 though 32 will show the last date the vaccine was administered.