Guidelines for Influenza Vaccinations

Please follow the guidelines below to administer influenza vaccinations for Blue Cross and Blue Shield of Texas Medicaid adults and CHIP Perinate mothers (age 18 and older):

• Follow the Texas State Board of Pharmacy rules related to certification to immunize and vaccinate (Texas Administrative Code, Title 22, Part 15, §295.15).
• Process these claims using the pharmacy‟s NPI.
• The pharmacy must be enrolled in the Vendor Drug Program (VDP) and be a member of an Express Scripts network.
• Use the same billing method as defined for Medicare Part D vaccine administration billing.
• For Submission Clarification Code field 420-DK, please enter "7"

Effective 01/01/2015: SC PEBA will cover Zostavax (shingles vaccine) at a $0 copay to any members aged 60 and above. This applies to the Commercial and Medicare Part D plans.

Beginning Feb. 1, 2015, Express Scripts will be the pharmacy benefits manager (PBM) for Amerigroup Louisiana Medicaid members.

Effective February 1, 2015, US Script Medicare/MMP New Client: Absolute Total Care, will be processing claims through Argus Health Systems.

The Payer Sheet for Buckeye Community Health Plan – My Care Ohio (Opt Out) has been updated to reflect an updated plan specific contact phone number.