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Anthem COVID-19 Conversations: Vaccination Reimbursement and Administrative Policies Update

Anthem is committed to supporting care providers and protecting members and communities against COVID-19. Anthem is encouraging all members to get vaccinated and they’ve created a consistent and simple approach to reimburse providers for administering the vaccine.


Vaccine reimbursement

The federal government will initially pay for FDA-approved COVID-19 vaccines. Anthem will reimburse for the administration of FDA-approved COVID-19 vaccines at the established national Centers for Medicare & Medicaid Services (CMS) rates, unless otherwise required by state directives, for members of fully-insured employer and Individual plans, as well as self-funded plans. Anthem will cover the vaccinations with no cost share for providers both in and out of a member’s network during the national public health emergency. The federal mandate does not allow providers to balance-bill members for vaccines or the administration of vaccines.


Temporary adjustments to administrative policies

Based on the impact to the healthcare system due to COVID-19 surges across the United States, Anthem will continue to make temporary adjustments to certain administrative and clinical policies. These temporary policy adjustments allow Anthem to ensure members receive care when they need it.


For example, prior authorization requirements have been suspended for patient transfers from hospitals to skilled nursing facilities or any other lower level of care. Some states have also put in place additional clinical and administrative mandates. Based on local needs, Anthem may also agree to state-specific clinical and administrative mandates that support member access to care. These temporary policy adjustments will apply to self-insured groups unless different intent is shared with Anthem. They can make changes to these options during their renewal period.


As a reminder, under the CARES Act, COVID-19 testing and vaccine administration is covered in full during the public health emergency. This applies to all members, regardless of the type of health plan they have or which doctor they choose to visit. The current public health emergency extension is effective January 21, 2021 and extends into April, and will likely remain in place for the entirety of 2021.


Visit Anthem’s COVID-19 Resource Center site for important updates and helpful tools and resources. Share Anthem's COVID-19 Test Site Finder tool with your clients to help members find nearby testing locations.


For questions, please contact a member of your B&P Sales Team - 888.722.3373.