Submit flu shots, other vaccines as medical claims, not pharmacy claims, for Blue Cross non-Medicare members

We recently learned that some pharmacies have been submitting claims for flu shots and other vaccines for Blue Cross Blue Shield of Michigan non-Medicare members as pharmacy claims. Claims for flu shots and other vaccines for Blue Cross non-Medicare members should be submitted as medical (professional) claims.

Only pharmacies that are part of Blue Cross Blue Shield of Michigan’s Vaccine Affiliation Program can submit claims for vaccines to Blue Cross members.

Which members are covered?
Before giving a flu shot, be sure the member has immunization coverage. You can check coverage on web-DENIS or by calling Provider Inquiry at the number listed for your area code.

**Only the following counties within this area code should call this number: Alcona, Alpena, Crawford, Iosco, Montcalm, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle and Roscommon.

You can use the following procedure codes when checking for coverage.

Submitting claims for flu shots and other vaccines:
Be sure to submit claims for flu shots and other vaccines administered to Blue Cross Blue Shield of Michigan non-Medicare members as medical (professional) claims through the medical claim system used by your pharmacy. You can work with your claim clearinghouse vendor or IT department if you are unsure of how to bill medical claims in your system. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid.

For members with Blue Care Network coverage:
For members with BCN commercial coverage, continue to follow the BCN billing process for vaccines.

For Medicare Advantage members:
For members with Medicare Advantage, continue to follow the Medicare Advantage billing process for vaccines.