COVID-19 Coverage Assistance Fund
The COVID-19 Coverage Assistance Fund will provide claims reimbursement at the national Medicare rate for eligible healthcare providers administering authorized COVID-19 vaccines to underinsured individuals.
To participate, providers must attest to the following at registration:
- Have submitted a vaccine administration claim to the patient's healthcare plan and 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
- Have verified that no other payer will reimburse them for COVID-19 vaccine administration fees for that patient, or other patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance
- Will accept defined program reimbursement as payment in full
- Agree not to bill the patient for any balance
- Agree to program terms and conditions and may be subject to post-reimbursement audit review
Providers are eligible for claims reimbursement if they have administered 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).
The provider must have first submitted the claim to the individual's health plan for payment and had the claim denied or only partially paid.
Vaccine administration reimbursement will be based on national Medicare rates for administering the COVID-19 vaccine:
- 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
First, create a provider account. Once enrolled, eligible providers and pharmacies may submit claims through their current clearinghouse or through the Coverage Assistance Fund portal.
- Frequently asked questions
- Claim submission guide
- Provider portal guide
- Educational toolkit for stakeholders and associations
May 12, 2021 provider webcast
2:00 p.m. Eastern
For complete information about funding programs, including your application status, please contact funders directly. Summaries are provided for your convenience only. RHIhub does not take part in application processes or monitor application status.