Knowledge is power. Knowledge shared is power multiplied.
December 2020

As we bid goodbye to the history-making year of 2020, I am happy to say that we made it! The pandemic has affected all of us, globally and personally. It's a year that may be gone but will never be forgotten. As we often do at this time of the year - pause and reflect, how would you sum up 2020?

2020 was a year of _________ (fill in the blank).

Perhaps, 2020 was a year of loss, acceptance, and change.

Loss. It was a year of unimaginable loss. Loss of loved ones, directly or indirectly, due to COVID-19. 344,877 people have lost their lives due to illness related to COVID-19. Loss of jobs - 20.8 million people lost jobs in April alone. Loss of the opportunity to celebrate special events with families and friends. Loss of innocence. The amount of pain and suffering may lessen with time but a hole will ever remain in our hearts.

Acceptance. There is no word that can comfort; there is only acceptance. Accept what happened and what it is. Accept that we are all different, with differing opinions and stances on the pandemic and the politics. At the end of the day, we are all just trying our best. Let's embrace what makes us unique and let go of frustration and hatred.

Change. The pandemic has permanently altered the way we live and work. On the positive side, it has accelerated some already existing trends such as remote work and telemedicine. Though the effects of the pandemic are hard to predict, we will have to be open to these changes and adapt to the "new normal" in the not-too-distant future.

On my hike this morning in my beloved San Gabriel mountains, the sun rose as beautiful and as ever. I can't help but feel optimistic and hopeful.

As we welcome 2021 and making goals, how would you envision the new year?

2021 will be a year of _______________ (fill in the blank).

May you find hope, inspiration, and courage to achieve physical, mental, and financial health!

Here comes the sun (doo-doo-doo-doo)
Here comes the sun, and I say
It's all right

Happy New Year!

COVID-19 Vaccine: What You Need 2Know
As of December 18, 2020, the U.S. Food and Drug Administration has issued emergency use authorizations (EUA) for two vaccines for the prevention of COVID-19, allowing the Pfizer-BioNTech and Moderna COVID-19 Vaccines to be distributed in the U.S. Although both are authorized for the use of prevention of COVID-19, each has different storage, temperature, and dosing requirements.
How Does This Impact You?
Different temperature storage requirements for approved COVID-19 vaccines may affect which vaccine will be easily accessible to you in the future.

In order to get your organization ready for administering the vaccine, you will need to be able to adhere to manufacturer and CDC guidelines for storing and handling vaccines, vaccination schedules, and monitoring and reporting any adverse events.

Now more than ever, with the introduction of the COVID-19 vaccinations, receiving immunization certification at your organization is the the key to success. Certifying your pharmacy or clinic demonstrates your ability to adhere to manufacturer and CDC guidelines, follow best practices, and properly administer the vaccination.

Contact us if you have any questions on Immunization Certification programs or how to get your organization ready.
For the latest instructions on the preparation and administration of the COVID-19 vaccination, please refer to the FDA fact sheet for healthcare providers.
COVID-19 Vaccine Claims Processing
COVID-19 Vaccine claims need to be submitted in accordance with the Express Scripts Provider Manual for proper processing.
Submission Clarification Codes (Effective 12/28/2020) - Required Submission Clarification Codes (SCC) in NCPDP field for COVID-19 Vaccine claims:

  • 02 - Other (for first injection of vaccine)
  • 06 - Starter Dose (for all subsequent prescriptions)
  • For a single dose vaccine, submit SCC 02 - Other

Medicare - All Medicare Part D and Medicare Advantage claims must be processed as Medicare Part B Fee for Service, otherwise NCPDP rejections will occur.

Coverage Under Medical Benefit - The following NCPDP rejects indicate that the patient does not have pharmacy benefit coverage for the COVID vaccine:

  • 816 - Pharmacy benefit exclusion for vaccines
  • 818 - Medication administration not covered
  • 831 - (Medicaid) Product/Service may be paid under FFS

Consistent Manufacturer - If a member received a different manufacturer for the first vaccine than what is being submitted on the second claim, the claim will result in an NCPDP Reject 88 – DUR Reject Error. Use the following overrides if there is a clinical exception to continue with a different manufacturer for the second vaccine:

  • Professional Service: M0, P0, PE, R0
  • Result of Service: 1A, 1B, 1C, 1D, 1E, 1F, 1G

Basis of Cost Determination - Basis of Cost Determination 0 – Default and a drug cost of $0.01 should be utilized.  

Regulatory Updates
The California State Board of Pharmacy announced on December 14, 2020 that its waiver request to allow pharmacists to independently initiate and administer FDA authorized COVID-19 vaccinations has been approved.
The Centers for Medicare & Medicaid Services (CMS) has released a special MLN Connects article on vaccine payment codes for the administration of approved COVID-19 vaccines.
CMS has issued a revised MLN Matters Article for HHAs Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries, addressing updates related to payments made under the Home Health (HH) Prospective Payment System (PPS) for 2021.
Healthcare Providers: Review Guidance and Be Cautious of Accepting Any Gifts!

Just in time for the holiday season, the U.S. Department of Justice (DOJ) and the Department of Health and Human Services' Office of Inspector General (OIG) have issued warnings regarding giving physicians gifts as illegal inducements.

On October 29, 2020, the DOJ announced its first enforcement action for a violation of the Open Payments Program reporting requirements.

On November 16, 2020, the OIG issued a Special Fraud Alert regarding Anti-Kickback Statue implications.

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