Billing Guidelines for Roster Bills

Providers who are mass immunizers, and/or providers who chose to bill using the roster billing method, must submit immunization claims on a roster bill and accept assignment under Original Medicare on both the administration and vaccine. Physicians and other health care providers enrolled in the Medicare program should follow the billing guidelines below when submitting roster bills to Blue Cross and Blue Shield of Nebraska (BCBSNE):  

• At this time, BCBSNE can only accommodate roster billing on paper claims. 
• Providers may submit up to three rosters on a single CMS-1500 claim form for each type of vaccination.  
• Rosters may include information regarding multiple patients.  
• Typed rosters are preferred. If it is not typed, the roster information must be in blue or black ink and legible.  
• Do not fold your claim or roster forms.  

Mail your CMS-1500 claims and attached roster bills to the following address: 

Prime Therapeutics  
P.O. Box 20970  
Lehigh Valley, PA 18002-0970