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COVID-19 Vaccine Coverage Assistance Fund

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 (HRSA) COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees or does but typically has patient cost-sharing.

About the Program

HRSA will provide claims reimbursement to 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 underinsured individuals.

NOTE:  For Uninsured patients please use the HRSA Uninsured Patient Program

How it Works

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

What’s Covered

There is no cost to 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 the individual’s health plan for payment. Only those claims denied or for which a patient’s health plan assesses charges to the patient related to COVID-19 vaccine administration are eligible for reimbursement and may be submitted to the Coverage Assistance Fund. Those claims include co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance.

Claims Submission

Create an account: https://covid19coverageassistance.ssigroup.com/

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 – $28.39.
  • Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses – $16.94.
  • Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses – $28.39.

For dates of service on or after March 15, 2021:

  • Administration (per dose) of a COVID-19 vaccine – $40.00.

Link to the complete article:  https://www.hrsa.gov/covid19-coverage-assistance

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