Vaccines Covered Under Medicare Part B
You can bill these through DocStation:
Flu (Influenza)
COVID-19
Pneumococcal (Prevnar)
Hepatitis B
Step 1: Submit the Claim to Medicare Part B
Always bill using:
BIN: 025656
PCN: CMS
✅ If the claim comes back paid, you’re all set.
Step 2: If the Claim Rejects
If you receive rejection code 41, this is actually helpful — it means the patient has a Medicare Advantage plan, and DocStation is giving you the correct billing details.
Example message
Eligible / Medicare Advantage: Yes / UHC Dual Complete (PCN 3270): 123ABC456 Rejected for additional information
What to pull from this message:
PCN: 3270
Subscriber ID: 123ABC456
What to do next:
Create a new insurance record in your PMS using:
BIN: 025656
PCN: (from the message)
Subscriber ID: (from the message)
Then rebill the claim.
Got a Different Rejection?
If the rejection code is something other than 41, check our guide to common BIN billing rejections and how to fix them.
Making It Easier: Start with These Plans
If you’re new to this workflow or doing back-billing, start with plans that are the most straightforward. These are common Medicare Advantage plans and typically follow consistent billing patterns:
Humana (plan numbers starting with “H”) — PCN: 2738
Optum / UnitedHealthcare — PCN: 3270
SilverScript (often linked to Aetna Medical) — PCN: 2067
Anthem / BCBS — PCNs vary (see state-specific BCBS plans here)
💡 Tip: These are the easiest plans to start with and are commonly seen in back-billing.
⚠️ Note: For Anthem/BCBS, always include the 3-letter prefix before the member ID (e.g., XYZ123456789). Missing this is a common cause of rejection.
Step 3: Subscriber ID Shows “Indeterminate”
Sometimes DocStation identifies the plan, but can’t retrieve the subscriber ID.
Example:
Eligible / Medicare Advantage: Yes / UHC Dual Complete (PCN 3270): Indeterminate
What this means:
The plan is confirmed, but the subscriber ID needs to be obtained manually.
Next Steps
Option 1: Get the card from the patient
Use the patient’s insurance card to obtain the subscriber ID.
Option 2: Bill to the PBM
Need to bill right away?
If you don’t have the subscriber ID yet:
Submit the claim to Part D temporarily
Once you have the subscriber ID, correct the insurance
Rebill the claim through Medicare Advantage
Optional: Check Eligibility First
To avoid rejections:
Open the patient profile
Run eligibility using their MBI
Review:
Medicare Advantage plan
Subscriber ID
PCN
Already Using Another Part B Vendor?
You can still use DocStation for Medicare Advantage.
If another vendor rejects a vaccine claim:
It likely means the patient has Medicare Advantage
Use the rejection details (PCN + subscriber ID)
Rebill through DocStation
Back-Billing Tip: Recover More Revenue
You may be able to increase reimbursement by rebilling past vaccine claims under Medicare Advantage instead of Part D.
Start with:
Humana
Optum / UnitedHealthcare
SilverScript
Anthem / BCBS (remember to include the prefix)
Steps:
Reverse the original Part D claim (within timely filing limits)
Create a new insurance record in your PMS:
BIN: 025656
PCN: correct Medicare Advantage PCN
Subscriber ID: from eligibility or rejection
Rebill through DocStation
⚠️ Be mindful of PBM timely filing limits when back-billing
Need Help?
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