FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration
Catalog of Federal Domestic Assistance number (CFDA): 93.461
The UIP provides reimbursements to eligible providers/pharmacies for claims attributed to the testing, treatment, or vaccine administration for COVID-19 for uninsured individuals. NCPDP claims are not accepted. Pharmacy providers need to enroll in the UIP portal. Once enrolled, claims should be submitted for reimbursement electronically outside of the program portal through the medical EDI 837 process (PDF) using Payer ID 95964 (COVID19 HRSA Uninsured Testing and Treatment Fund). This is similar to billing COVID-19 vaccines to the Medicare medical benefit instead of the pharmacy benefit. More information on the claim submission process can be found under Claims & Reimbursement or on our provider checklist.
A clearinghouse/medical intermediary is an organization that enables the exchange of healthcare data between the provider and the payer (insurance company). It is the only HIPAA covered entity that can translate between standard and non-standard transaction formats. As such, clearinghouses/medical intermediaries provide solutions that enable data submission from provider systems into the HIPAA 837 claim format required for claims submission and payment as part of this program. This can expedite the overall turnaround time from claim submission to payment.
See our list of Uninsured Program (UIP) participating clearinghouses/medical intermediaries (PDF). Providers that utilize a clearinghouse/medical intermediary not listed should contact their current vendor to ensure they establish a partnership with one of UIP’s designated clearinghouses/medical intermediaries.
No. Providers/pharmacies need to enroll in the UIP portal and complete initial steps, such as validating their provider TIN and adding their provider roster, but other steps, like registering for direct deposit/ACH through Optum Pay™ and submitting claims, must be done outside of the program portal. See our provider checklist for a step-by-step guide on how and where to complete the process, expected timeframes, and links to helpful resources.
No. Pharmacies will typically fill out the tab titled “Hospital_Ancillary_Clinic”. If the “Hospital_Ancillary_Clinic” tab is completed, individual pharmacists do not need to be listed on the provider roster. If a pharmacy’s National Provider Identifier (NPI) is assigned per service location and claims are billed at this level, the provider should complete the “Hospital_Ancillary_Clinic” tab and fill out one row per taxpayer identification number (TIN)/NPI/service location.
No. The Uninsured Program utilizes Optum Pay™ (through OptumBank®) as the administrator of direct deposits/automated clearing house (ACH) setups and payments to providers. This is not the same as OptumRx®, the Pharmacy Benefit Manager (PBM) for pharmacy benefits.
Pharmacies/pharmacists and those operating under their supervision who are legally authorized, including those authorized by operation of the Public Readiness and Emergency Preparedness (PREP) Act, to order and/or administer testing or vaccination services are eligible to request reimbursement for testing or vaccination administration under this program.