Provider Notice Issued 04/08/2021

To:       Enrolled Hospitals:  Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers

Re:      COVID-19 Vaccine Administration Performed in Hospital-Based Outpatient Settings

This notice informs hospitals of the appropriate process for billing COVID-19 vaccine administration performed in hospital-based outpatient settings. The billing direction applies to claims for persons covered under both traditional fee-for-service and a HealthChoice Illinois managed care plan. 

As an exception to current hospital outpatient billing policy, the Department will reimburse COVID-19 vaccine administration in hospital-based outpatient settings via the 837 Professional claim format. While any qualified practitioner can administer the vaccine, hospitals must use the Medical Director, Chief Medical Officer, or other authorized practitioner name and NPI as the Rendering Provider in NM1, Rendering Provider Name, Loop 2310B, on the 837P claim. This authorized practitioner must be registered in IMPACT. The billing information in NMI, Billing Provider Name, Loop 2010AA must be linked to the Rendering Provider Name and NPI.   

Institutional claims for vaccine administration that have already been submitted and paid should be voided and the service rebilled through the professional claim format. 

The chart below identifies the current coding and rate structure for vaccine administration. Hospitals are encouraged to refer to the COVID-19 Updates webpage for the most up-to-date COVID-19 provider information, including updated COVID-19 fee schedules.