FLASH: Provider Vaccine Notice for Medicare Members

This statement is to inform you that beginning 03/01/2022, medical claims for vaccines eligible for coverage under Medicare Part D that are billed to Health Alliance™ will be disallowed. This change is being made to better reflect current industry standards, better follow CMS guidance and to allow a more straightforward billing process to better serve our members.

Medicare Part D covered vaccines are those that are not related to the treatment of an injury or direct exposure to a disease or condition. Influenza, Pneumococcal and other Part B eligible immunizations however, will continued to be covered when submitted as medical claims for Medicare Advantage members.

Previously, claims for Part D covered vaccinations (e.g., Shingrix) given in the provider office and billed medically were being denied and members were held liable for the full cost of the vaccine. Going forward these claims will be made non-payable due to non-covered services.

These vaccines are available at in-network retail pharmacies that have the ability to bill Part D claims directly to our pharmacy benefits manager, OptumRx. Members will then be responsible for only their plan copays at point-of-sale.

For any questions about vaccine coverage please call (217) 902-8954.