H1N1 Flu Administration Fee Billing

eRx Network, an Emdeon company, provides a 5.1 to 837P H1N1 administration fee billing solution for retail pharmacies that desire an electronic alternative to the paper roster billing process. Using existing pharmacy systems, H1N1 administration fees can be easily billed to the nation’s top medical payers via the NCPDP 5.1 transaction set.

With this electronic billing solution, retail pharmacies submit 5.1 transactions to eRx Network using BIN 004766 and the PCN of H1N1. In addition to the typical 5.1 data elements needed for Part B flu billing, other data fields that must be included are the five-character payer ID in the plan ID field and the insurance plan group number in the group ID field (if required).

From there, eRx Network attempts an eligibility check (270/271) for each claim and returns an eligibility status response when available. If eligibility is not available from the payer, a returned message indicates that eligibility was not verified. With plan pre-edits satisfied, the claim is then accepted into our system for billing.

eRx Network will bill the administration fee at the U&C transmitted from the pharmacy system, and will NOT perform pricing edits or adjustments. Billing will occur via a standard 837P transaction using Emdeon’s extensive medical network connectivity. 

Retail pharmacies not enrolled with the payer for medical services electronic remittance advice (ERA) should expect to receive paper remittance from the payer.

In addition to the H1N1 flu billing solutions being provided to eRx Network pharmacy customers, other Emdeon/eRx customers that operate Emdeon Office, a multi-payer portal for medical revenue cycle management, are able to process claims for H1N1 administration electronically. Emdeon Office allows these providers to verify medical eligibility for more than 500 payers nationally, submit and track claims, and manage any changes to those claims through web-based software.