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Flu Vaccine Billing–Information for Providers

VA’s Community Care Network (CCN) retail pharmacies and urgent care clinics provide eligible Veterans with flu vaccines paid for by VA.

If you are part of CCN, read on to learn how to provide a flu shot to eligible Veterans and how to be reimbursed.

Community Care Network (CCN)

IMAGE: Fighting the Flu Together!

Providing a Flu Vaccine

1. Identify your CCN region and steps for reimbursement by scanning the provider billing information QR code or follow the steps below.

  • CCN Regions 1-3, administered by Optum®/CVS Caremark®
    If you are located in the following U.S. states and/or territories: AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI or WV.

    Call Optum at 800-364-6331 to confirm you are in-network.

Scan or click the QR code below for provider billing information.
QR Code to the Billing Information Card

  • CCN Regions 4-5, administered by TriWest Healthcare Alliance®/Express Scripts®
    If you are a retail pharmacy or urgent care provider located in one of the following U.S. states: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, TX, UT, WA or WY.

    Call TriWest at 800-922-1557 to confirm you are in-network.

2. Confirm the Veteran’s identity by checking their government-issued ID.

3. Check the Veteran’s eligibility for a flu vaccine paid for by VA:

  • Ask for the Veteran’s 10-digit Veteran ID number, then check their eligibility electronically.
  • If you can’t check their eligibility electronically, call Optum (Regions 1-3) or TriWest (Regions 4-5) to confirm their eligibility. The system will indicate urgent care eligibility which includes flu vaccines.
  • If Veteran doesn’t have or know their 10-digit Veteran ID number, ask for their Social Security Number (SSN), then call Optum (Regions 1-3) or TriWest (Regions 4-5) to confirm their eligibility. The system will indicate urgent care eligibility which includes flu vaccines.

Optum (Regions 1–3): 888-901-6609

TriWest (Regions 4 & 5): 833-483-8669

4. Enter the electronic billing information below according to your CCN region:

Regions 1-3 (Optum/CVS Caremark™)

  • Step 1: Enter BIN: 004336
  • Step 2: Enter PCN: ADV
  • Step 3: Enter Rx Group: Flu Shot or COVID-19 Vaccine: Rx3841
  • Step 4: Enter 10-digit Veteran ID or SSN
  • Step 5: Enter Veteran’s date of birth (YYMMDD format)

Questions?
CVS Caremark™ Pharmacy Help Desk
800-364-6331 (Open 24/7)

Regions 4-5 (TriWest/Express Scripts)

  • Step 1: Enter BIN: 003858
  • Step 2: Person Code: 01
  • Step 3: Enter PCN: A4
  • Step 4: Enter Rx Group: Flu Shot or COVID-19 Vaccine: VAPC3RX
  • Step 5: Enter 10-digit Veteran ID or SSN
  • Step 6: Enter Veteran’s date of birth (YYYYMMDD format)

Questions?
Express Scripts Pharmacy Help Desk
800-922-1557 (Open 24/7)

5. Administer the flu vaccine.

6. Send flu shot documentation to VA.

  • Retail pharmacies can provide a copy of the flu shot documentation to the Veteran to provide to their VA primary care provider’s office.
  • Urgent care providers can ask the Veteran for the name and location of their home VA medical center and submit the flu shot documentation to that facility within 30 calendar days of the date of service.

Find a VA medical facility online using the VA Facility Locator.

IMPORTANT: Do not charge eligible Veterans any type of fee or copayment for receiving the flu vaccine.

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