How to bill Aetna for administering the H1N1 flu vaccine

Aetna members may choose where they go to get the H1N1 flu vaccine. Non-physician providers can now bill Aetna for administration of the H1N1 vaccine to our members.

Due to concerns about the H1N1 flu pandemic, we will cover the administration of this vaccine at no out-of-pocket cost to members. Aetna will provide this coverage even in instances where members’ specific health plans do not provide coverage for preventive care or have limits on such coverage. We will do this even for plans where the employer pays the health care claims (self-funded plans) unless the employer asks us not to provide the benefit.

Is your organization a pharmacy or other “non-traditional” provider approved as an H1N1 vaccinator?  If so, please see the direction below on how to bill Aetna for administration of this vaccine.

Who can submit claims

• All providers approved as H1N1 vaccinators, including pharmacies, may bill Aetna for Commercial and Medicare members with medical coverage through Aetna.  This is subject to the member’s eligibility plan.  
• Administration of the H1N1 vaccine is covered under medical plans. 
• Aetna will not cover administration of the H1N1 vaccine for members only covered under Aetna’s Medicare Prescription Drug Plans (Part D only). 
• Aetna will pay for claims only for the administration of the H1N1 vaccine.  While we will accept rosters with the codes for the H1N1 vaccine itself (CPT 90663 or HCPCS G9142) in the header information, we will not pay for the vaccine.  The federal government will provide the vaccine and supplies needed to administer it directly to approved vaccinators. 

Submit the following codes for billing of the administration of H1N1 vaccine only:

• CPT code 90470 or
• HCPCS code G9141. 

All other CPT/HCPCS codes will receive a rejection message.  The H1N1 roster billing process should not be used for billing of the seasonal flu vaccine. 

Claim submission

• Medical claims clearinghouses - If your pharmacy already has a process in place to file electronic medical claims, you may use this for H1N1 vaccine administration. Examples of medical claim clearinghouses include Emdeon, NaviNet and ZirMed.  Claims submissions using these vendors are sent like any other medical or Medicare Part B claim submission.
  
• New, free electronic roster billing - To bill electronically, Aetna has contracted with ZirMed to provide free electronic billing for the administration of the H1N1 vaccine. 
  
• ZirMed’s site provides details on how to enroll, upload rosters electronically and work through a rejection online. Click here to begin the enrollment process.
  
• Once you have registered with ZirMed, you can download an Excel template roster bill here. Complete and upload roster bills electronically through ZirMed. See a sample completed roster bill.
  
• For those providers who are unable to submit H1N1 vaccine administration claims through the above process, please print a copy of the PDF roster bill form.  See a sample completed roster bill. Please fill this form out completely and mail it to:
  
  Aetna – H1N1 Roster Billing
  P.O. Box 659560
  San Antonio, TX 78265-9560

This P.O. Box has been established for the submission of paper billing rosters for the H1N1 vaccinations only.

Electronic Remittance Advices (ERAs)
If a request for medical ERA is not made, the provider will receive paper Explanation of Benefits (EOB).

There are multiple options available to receive your Medical ERAs. These include:

• ERA through your current vendor/clearinghouse - Ask your vendor/clearinghouse if it can deliver Aetna's Medical ERA transaction. If so, ask how it can assist you in the enrollment process.
• Vendor/clearinghouse - If you do not currently have a vendor/clearinghouse, please call the ZirMed Help Desk at 877-494-7633 and select Option 2. Or you may select another clearinghouse from the link below: 
  http://www.aetna.com/provider/medical/service_med/electronic_med/clearinghouse.html 
• Downloadable, text-readable ERA – This is available through the Aetna Secure Provider Website via NaviNet.  To register for the website, click here: 
  https://enroll.navimedix.com/enrollment/shared/office-search 
• Secure Website - Aetna EDI Connect is Aetna's web-based solution to receive ERAs via a secure FTP.  For more information or to register: 
  https://www.aetnaedi.com/tpp/login/index

For more information on how to enroll for Aetna Medical ERAs, including the ERA enrollment packet, please visit our website at: http://www.aetna.com/provider/medical/service_med/electronic_med/transactions.html  

Things you should know about Aetna Medical ERAs:

• Medical ERAs are produced on a daily basis, whereas Pharmacy ERAs are produced on a weekly basis. 
• Medical ERAs are created for finalized/adjudicated claims only. Pended claims are not included on an ERA.
• Medical ERAs will contain all medical claim payments, not just the H1N1 claim payments.
• There will be some differences in content on the Medical ERA.
• The ERA replaces the paper EOB. Once set up for ERA, your paper EOBs will be discontinued.