Mass Immunization - JE Part B

Learn how to enroll the Mass Immunization specialty.

• Mass Immunization
• Billing
• Application Completion
• Effective Dates
• Supporting Documentation

Mass Immunization

• Information is found in CMS Internet Only Manual (IOM), Publication 10-108, Medicare Program Integrity Manual, Chapter 10; 10.2.4
• A mass immunizer may not bill Medicare for any services other than pneumococcal pneumonia vaccines (PPVs), influenza virus vaccines and their administration
• They must submit claims through the roster billing process
  • Roster billing simplifies billing claims by allowing mass immunizers to submit one claim form with a list of several immunized beneficiaries.
• The supplier, as well as all personnel who administer shots, must meet all applicable state and local licensure or certification requirements.
• Mass immunizers can be one of these types:
  • A traditional Medicare provider or supplier, such as a hospital outpatient department
  • Shared location with a Pharmacy to administer the vaccines

Billing

• To learn more about billing, view the billing portion of our website:
  • Influenza Virus Vaccine and Administration
  • Pneumococcal Vaccine and Administration

Application Completion

• If completing application via PECOS, ensure application questionnaire is answered correctly. CMS-855B, CMS-588 (Electronic Funds Transfer (EFT)) application will populate.
• If completing application via paper, the following must be submitted:
  • CMS-855B (Organization)
  • CMS-588 (EFT)
• A voided check or signed bank letter is necessary documentation for EFT portion of application
• Must include legal business name (LBN) of the enrollment, routing and account number and practice address
• Submit application fee
  • Fee is required for application. Shall be paid on PECOS website
  • Select pay application fee on right-hand side under Helpful Links

Effective Dates

For additional information regarding effective dates refer to CMS Internet Only Manual (IOM), Program Integrity Manual, Chapter 10, 10.6.2 Establishing Effective Dates

Supporting Documents

• IRS document required for the following types of enrollment applications:
  • Initial enrollment
  • A change of legal business name
• A voided check or signed bank letter is necessary documentation for EFT portion of application
  • Bank letter must include the following:
    • On bank letterhead
    • Signed by bank representative
    • Full account legal name as found on IRS and NPPES registry
    • Full account number
    • Full routing number
    • Type of account (checking or savings)
• Submitting by paper application, submit CMS-588 Electronic Funds Transfer Agreement
• Submitting by paper application, submit CMS-855B enrollment application