Frequently Asked Questions
What information can I obtain from the Merck Vaccine Reimbursement Support Center?
- The MVRSC can provide you with certain coding information for Merck vaccines and the administration of those vaccines.
- The MVRSC can help you to determine reasons for insufficient reimbursement and/or denied claims from a particular insurance company, and provide sample letters for re-submission if appropriate.
- The MVRSC can assist you with the insurance verification (up to five (5) verifications per month, for each office location within the same health care practice), and Prior Authorization processes.
- The MVRSC can explain which Merck adult vaccines may be covered under Medicare Part D, and how the claims process works.
- The MVRSC can provide general reimbursement information that it has on file.
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How can I find out if my patient's health plan will reimburse for a Merck vaccine?
Specific reimbursement rate information may be obtained by contacting the payer's provider relations department or representative. To access rate information, the provider may require your National Provider Identifier (NPI) or Tax Identification Number and/or provider number.
For help from an MVRSC specialist, complete a Request for Benefit Information Form or call 1-800-734-6282 to request a form. A reimbursement specialist will attempt to contact the payer to determine if the patient's insurance will cover the vaccine. The MVRSC only conducts insurance verifications for Commercial and Medicaid Managed Care plans.
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What CPTa and ICD-9-CMa codes are commonly used when I submit claims to private payers for certain Merck vaccines?
To find this information, check the Reimbursement Codes page of this Web site. There, you will find this information sorted by code and by category.
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Are Merck's adult vaccines reimbursed under Medicare Part D? How can claims be submitted for vaccines reimbursed by Medicare Part D?
The MVRSC can explain which Merck adult vaccines may be covered under Medicare Part D, and how the claims process works. You may also call 1-800-734-6282 to speak with an MVRSC reimbursement specialist.
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What if a health plan denies or underpays my reimbursement claim?
The MVRSC can help you to determine reasons for insufficient reimbursement and/or denied claims from a particular insurance company. Complete a Request for Benefit Information Form or call 1-800-734-6282 to request a form. Return the form with the patient's Explanation of Benefits (EOB). A reimbursement specialist will research the denied/underpaid claim for you or provide you with suggestions for resubmitting. The MVRSC only provides claim support for Commercial and Medicaid plans.
You can also find sample letters that may be helpful for re-submission if appropriate.
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How can I get a prior authorization for a Merck vaccine?
Complete a Request for Benefit Information Form or call 1-800-734-6282 to request a form. A reimbursement specialist will work with your office and the payer throughout the process of obtaining an authorization.
You can also find vaccine-specific pre-certification letters on the Reimbursement Claim Support Letters page.
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What if I can't find the answer I'm looking for on the site?
Please call the MVRSC at 1-800-734-6282 between the hours of 9:00 am and 8:00 pm (ET), Monday through Friday.
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What if I want to speak to a live person?
Please call the MVRSC at 1-800-734-6282 between the hours of 9:00 am and 8:00 pm (ET), Monday through Friday.
The Merck Vaccine Reimbursement Support Center professional staff will provide personalized assistance for appropriate billing, coding or other claims submission procedures related to Merck vaccines.
The Reimbursement Specialists are accustomed to working with all management levels regarding claims, case management, provider relations and benefit plan issues related to insurance reimbursement matters, across all major health insurers.
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When is telephone support available?
MVRSC specialists are available at 1-800-734-6282, Monday through Friday, between the hours of 9:00 am and 8:00 pm (ET).
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