Public Assistance Simplified Application

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The Coverage Assistance Fund (CAF) stopped accepting claims for vaccine administration due lớn a lack of sufficient funds. Confirmation of receipt of your claim submission does not mean the claim will be paid.

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*Submitted claims will be paid subject lớn the availability of funds.

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View the menu of providers who have received a reimbursement from the nhatroso.com COVID-19 Coverage Assistance Fund (CAF) program.


The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. Accordingly, the Health Resources and Services Administration’s (nhatroso.com) COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines khổng lồ patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. While patients cannot be billed directly for COVID-19 vaccine fees, costs lớn health care providers on the front lines for administering COVID-19 vaccines to underinsured patients will now be fully covered through CAF, subject to lớn available funding. As vaccination efforts accelerate, patients will increasingly gain access khổng lồ COVID-19 vaccines at locations near where they live with providers they trust.

Providers who have administered Food & Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to lớn underinsured individuals, on or after December 14, 2020 (the first date of vaccine distribution in the United States), may now submit their COVID-19 vaccine administration fee claims for reimbursement consideration to the CAF. Lớn be eligible for reimbursement, the provider must have first submitted the claim to lớn the individual’s health plan for payment & had the claim denied or only partially paid.

Providers can access the CAF Portal

View Frequently Asked Questions

Note that providers who have administered COVID-19 vaccines lớn uninsured patients on or after December 14, 2020 are eligible to lớn submit claims for reimbursement to lớn the nhatroso.com COVID-19 Claims Reimbursement to lớn Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured nhatroso.com Uninsured Program).

About the Program

nhatroso.com will provide claims reimbursement lớn eligible health care providers at the national Medicare rate for administering Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to lớn underinsured individuals.

Section 3203 of the CARES Act và its implementing regulations generally require non-grandfathered group health plans và health insurance issuers offering non-grandfathered group or individual health insurance coverage to lớn cover any qualifying coronavirus preventive service, including recommended COVID-19 vaccines and their administration, without imposing any cost-sharing requirements, such as a copayment for vaccine administration, co-insurance, or deductible for vaccine administration, during the COVID-19 public health emergency.

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However, certain health plans are not subject khổng lồ this requirement. Examples include grandfathered health plans, excepted benefits, or short-term limited duration insurance plans. The Centers for Medicare và Medicaid Services (CMS) is encouraging, but cannot require, such plans to lớn cover vaccine administration without cost-sharing. Some states may require these plans khổng lồ cover vaccine administration.

Currently, all organizations & providers participating in the Centers for Disease Control and Prevention’s (CDC) COVID-19 Vaccination Program (which currently includes any providers who may be administering vaccine khổng lồ individuals) must administer the COVID-19 vaccine, regardless of the vaccine recipient’s ability khổng lồ pay. Providers are not allowed to seek any reimbursement from vaccine recipients, but may seek reimbursement from a program or plan that covers COVID-19 vaccine administration fees. Vaccine administration fees for uninsured individuals are currently covered through nhatroso.com’s Uninsured Program. The Coverage Assistance Fund extends the same màn chơi of support to providers who administer vaccines to lớn underinsured individuals.

How it Works

Health care providers can request claims reimbursement, through the COVID-19 Coverage Assistance Fund electronically và will be reimbursed at the national Medicare rate for vaccine administration, and for patient charges related khổng lồ COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance, subject to lớn available funding.

Before submitting a claim to lớn the COVID-19 Coverage Assistance Fund, the provider must submit a claim for vaccine administration to the individual’s health plan for payment và have the claim denied or only partially paid. Providers are not required to lớn ascertain a patient’s immigration status in order khổng lồ receive reimbursement from the fund.

To participate, providers must attest to lớn the following at registration:

They have submitted a vaccine administration claim to the patient’s health care plan & confirmed that the patient has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccination but with cost-sharing. (Certain health plans are not required to provide coverage of qualifying coronavirus preventive services, including recommended COVID-19 vaccines & their administration, without cost-sharing under section 3203 of the CARES Act. Examples include grandfathered health plans, excepted benefits, or short-term limited duration insurance plans.)They have verified that no other payer will reimburse them for COVID-19 vaccine administration fees for that patient, or other patient charges related lớn COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, và co-insurance.They will accept defined program reimbursement as payment in full.They will agree not khổng lồ balance bill the patient.They will agree to lớn program terms & conditions và may be subject to post-reimbursement audit review.

What’s Covered

There is no cost to lớn health care providers for COVID-19 vaccines received from the federal government, therefore, providers are expected to submit a claim for only vaccine administration to lớn the individual’s health plan for payment. Only those claims denied or for which a patient’s health plan assesses charges lớn the patient related lớn COVID-19 vaccine administration are eligible for reimbursement & may be submitted to the Coverage Assistance Fund. Those claims include co-payments for vaccine administration, deductibles for vaccine administration, & co-insurance. Claims will be subject lớn Medicare timely filing requirements, thus must be submitted within 365 calendar days from the date of service. All claims submitted must be complete và final. Providers who receive reimbursement from the COVID-19 Coverage Assistance Fund cannot also receive reimbursement for such vaccine administration from the individual or other source.

Claims Submission

Once enrolled, eligible providers and pharmacies can submit claims through their current clearinghouse or submit a claim electronically or manually through the Portal.

Claims Reimbursement Rate

Claims for reimbursement will be priced as described below for eligible services:

Vaccine administration fees will be priced based on national Medicare rates for administering the COVID-19 vaccine (not geographically adjusted) and are outlined below:For dates of service through March 14, 2021:Administration of a single-dose COVID-19 vaccine - $28.39Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses - $16.94Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses - $28.39For dates of service on or after March 15, 2021:Administration (per dose) of a COVID-19 vaccine - $40.00For COVID-19 vaccinations administered in-home* with dates of service on or after June 8, 2021:Administration (per dose) of a COVID-19 vaccine - $75.50Reimbursement will be based on incurred date of service.Publication of new codes và updates to lớn existing codes will be made in accordance with CMS.For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information.

Resources

Informational resources are available for providers interested in learning more about the nhatroso.com COVID-19 Coverage Assistance Fund:

May 12, 2021 Webcast: nhatroso.com COVID-19 Coverage Assistance Fund

For more information about the program, access: