What if a provider submitted a claim to the HRSA COVID-19 Uninsured Program and the patient is actually underinsured?

If a claim was submitted to the HRSA COVID-19 Uninsured Program for a patient who was actually insured, the provider should receive a notice that the claim was not eligible for reimbursement. If the claim was for COVID-19 vaccine administration and the patient’s health plan either did not include COVID-19 vaccination as a covered benefit or covered COVID-19 vaccination but with cost-sharing, then the provider could instead submit the claim to the HRSA COVID-19 Coverage Assistance Fund. Prior to submitting a claim to the Coverage Assistance Fund, the provider should first submit the claim to the individual’s health insurance plan for payment. Only those COVID-19 vaccine administration claims denied or not fully paid by a patient’s health insurance plan, including those insurance plans with patient co-pays for vaccine administration, deductibles for vaccine administration, or co-insurance related to COVID-19 vaccination, are eligible for reimbursement by the HRSA COVID-19 Coverage Assistance Fund.