REMINDER: Amerigroup members influenza vaccine submission process

In order to provide an efficient process for their members, Amerigroup and Express Scripts are providing these tips for members seeking influenza vaccines in the State of Texas:

• The pharmacy must submit the claim using the pharmacy’s National Provider Identifier (NPI) and be enrolled with the Vendor Drug Program (VDP) and your pharmacy benefit manager (PBM).

• The pharmacy must submit a claim that includes the “Professional Service Code” field (44Ø-E5) with the value “MA” (Medication Administration) in the DUR/PPS segment for the service as well as the appropriate national drug code (NDC) for the vaccine in “Product/Service ID field” (4Ø7-D7).

• The influenza vaccine will not be on the VDP Medicaid Formulary, the MCO/PBM must include a “7” in the “Submission Clarification Code” field (42Ø-DK)

Amerigroup member ID card sample

As a reminder, please submit Amerigroup member claims to Express Scripts using the following information:

If you need assistance processing a claim for one of these members, please call 844.367.6115.