Ocean State Immunization Collaborative 2016 State - Supplied Vaccine Workshop May 17, 2016

Topics Billing Guidelines Influenza Pneumococcal Conjugate Prevnar 13 (PCV13) Pneumococcal Polysaccharide Pneumovax 23 (PPSV23) Meningococcal Conjugate Menactra (MCV4) Meningococcal Serogroup B Bexsero (MenB-4C) Tetanus- Diphtheria- Pertussis (Tdap) Tetanus- Diphtheria (Td) Shingles Vaccine Vaccine Administration Billing & Reimbursement Non State-Supplied Vaccines

Influenza Billing Guidelines (Fluzone High Dose) Adults age 65 years & older (Flumist) Children ages 2 years - 18 years (Fluzone) Children ages 6 months - 35 months (Fluzone) Children ages 3 years – 18 years (Fluarix) Adults ages 19 years & older (Flulaval) Adults ages 19 years & older For more information, refer to: 1.Rhode Island Department of Health Pediatric and Adult State-Supplied Vaccine Guidelines 2.The Neighborhood website:

Pneumococcal Billing Guidelines (Prevnar 13) Children ages 12 months- 15 months Adults ages 19 years– 26 years Catch- up vaccination only 90732(Pneumovax 23) High- Risk Children Per the CDC Recommended Immunization Schedule Adults ages 65 years & older Catch- up vaccination only For more information, refer to: 1.Rhode Island Department of Health Pediatric and Adult State-Supplied Vaccine Guidelines 2.Our website:

Meningococcal Billing Guidelines (Bexsero) Children ages 16 years – 18 years Adults ages 19 years – 23 years (Menactra) High- Risk Children ages less than 11 years Per the CDC Recommended Immunization Schedule Children ages 11 years – 12 years; 16 year booster Unvaccinated College Students ages 19 years – 21 years Students living in a dorm Adults Per the CDC Recommended Immunization Schedule For more information, refer to: 1.Rhode Island Department of Health Pediatric and Adult State-Supplied Vaccine Guidelines 2.Our website:

Tetanus- Diphtheria- Pertussis and Tetanus- Diphtheria Billing Guidelines (Tenivac) Children ages 7 years & older with unknown/ incomplete series of Td vaccines Adult booster every 10 years & older (Boostrix) Children 11 years – 12 years Children less than 19 years Catch- up vaccination only Adults 19 & older Pregnant women with each pregnancy For more information, refer to: 1.Rhode Island Department of Health Pediatric and Adult State-Supplied Vaccine Guidelines 2.Our website:

Zoster (Shingles) Billing Guidelines (Zostavax) Adults ages 50 years & older For more information, refer to: 1.Rhode Island Department of Health Pediatric and Adult State-Supplied Vaccine Guidelines 2.Our website:

Vaccine Administration Billing and Reimbursement Vaccine Administration with counseling, Members ages 0 years -18 years 90460, and or will bundle and deny if billed together on the same day Vaccine Administration without counseling, All ages 90471, 90472, 90473, and will bundle and deny if billed together on the same day For more information, refer to: 1.Rhode Island Department of Health Pediatric and Adult State-Supplied Vaccine Guidelines 2.Our website:

Non State-Supplied Vaccines Neighborhood allows providers to purchase non state-supplied vaccines when they are on the CDC’s list of approved vaccines Non state- supplied vaccines can be billed in conjunction with vaccine administration codes, as appropriate For more information, refer to: Our website:

Informational Resources Provider Claims Services: (401) Member Services: NaviNet: navinet.navimedix.com Member Eligibility Claim Status Inquiries Links to Important Notifications Neighborhood Website:

Provider Network Management Contacts Charles Scaletta Manager of Primary Care Network (401) | Nancy Butera Senior Primary Care Network Administrator (401) | Ian Evans Primary Care Network Administrator (401) | Justin Jenkins Primary Care Network Administrator (401) |