Skip to content
English
Back to Outcomes
  • There are no suggestions because the search field is empty.

ComputerRx Vaccine Medical Billing

This article provides information on how a ComputerRx user can get set up and submit a vaccine medical claim for payment.

Submitting a Vaccine Fill for Medical Billing

When entering a vaccine fill in ComputerRx, follow these steps to submit the vaccine fill for medical billing through Outcomes:

Step 1: Enter the Vaccine Fill in the Pharmacy Management System (PMS)

  • Begin by entering the vaccine fill as you normally would in ComputerRx. No special formatting or alternate data entry is required for the fill itself. The process remains consistent with how you would enter any other fill.

Step 2: Add the Correct In-House Cash Plan to the Fill

  • To indicate that the claim should be submitted for medical billing, you must add the appropriate in-house cash plan to the fill. This signals to Outcomes that the claim should be processed through the patient’s medical benefit.
    • For ComputerRx Users:
      • Enter the Third-Party Company Name as OUTCOMES MEDICAL BILLING.

See below section on Setup Steps for Submitting Vaccines for Medical Billing for assistance on creating an In-House Cash Plan.

Step 3: Add a Diagnosis Code.

  • Ensure you enter a diagnosis code for the vaccine administration. 
  • A diagnosis code is required for the medical claim to be processed. The diagnosis code should be provided by the healthcare provider.

See Adding a Diagnosis Code Section below for tips on adding this to the fill.

Step 4: Submit 

  • Enter all other information in the PMS as you would any other fill.
  • Outcomes will attempt to bill the patient's insurance for both the vaccine product and vaccine administration.

Adding a Diagnosis Code to a Vaccine Fill

Including the appropriate diagnosis code with the vaccine fill is essential for compliance when billing medical claims. The code, provided by a qualified healthcare professional, ensures accurate billing and proper claim processing.

Adding a Diagnosis Code in ComputerRx

Follow these steps to enter a diagnosis code in ComputerRx:

  1. Navigate to the right rail options and select DUR, or press Alt + F6.
  2. Locate the Diagnosis Field.
  3. Enter the appropriate diagnosis code for the vaccine service.


📝 Note: The standard diagnosis code for a vaccine encounter is Z23, but this must be validated for accuracy and approved by the healthcare professional prior to administration.

ComputerRx Setup Steps for Submitting Vaccines for Medical Billing

Before submitting vaccine claims for medical billing, pharmacies need to configure their ComputerRx (WinRx) system to ensure proper claim submission. The two key setup steps involve updating employee records with the RPh NPI and setting up the In-House Cash Plan.

Step 1: Adding RPh NPI in Rx30

To ensure accurate submission of the Rendering Provider on the medical claim:

  1. Navigate to Utilities > Users and Passwords.
  2. Access the employee record.
    1. If Admin user - select the appropriate employee from the list.
    2. If non-Admin user - you will be taken directly to your own employee record.
  3. Enter or update the employee's NPI number in the "NPI" field.
  4. Click Save or Update to apply changes. 

Step 2: Setting Up the Third-Party Party Insurance in WinRx

  1. Navigate to the “Third Party” menu at the top of the WinRx Screen.
  2. Then select “Third Party Companies” in the drop down menu.
  3. Click on the “Add New Company” at the bottom of the screen.
  4. Input the name of the plan in the Name field.
    1. Enter the Third-Party Company Name as OUTCOMES MEDICAL BILLING
  5. Input the BIN as 026183.
  6. More specific settings can be added under the company Options columns.
  7. Click on Save (F12) at the bottom of the screen.