MedMe’s Medical Billing Suite runs your entire clinical services revenue cycle, from credentialing to reconciliation. See higher reimbursements on vaccine administration, tests, consults, and more, than when you bill through a Pharmacy Benefit Manager (PBM).
MedMe’s end-to-end system for pharmacy clinical billing, from credentialing to reconciliation, so you get paid for the care you already deliver.
When billing through a PBM, you only make a fraction of what you could be receiving per flu shot. Billing through the medical benefit with MedMe captures an administration fee on every dose, revenue that otherwise disappears. You’re already working around the clock to deliver on the rush of appointments, you should get paid for the work you’re already doing.
Figures are illustrative and reflect gross revenue on Michigan-specific reimbursement rates as of 2026. Revenue and potential varies by state and payer mix and may be higher in other markets.
Beyond flu season, billing for other clinical services like medication therapy management (MTM) allows you to better serve your community and bring in additional revenue for your pharmacy.
We handle enrollment and payer contracting to help you get billing-ready.
Book, document, and deliver the service. The clinical note becomes the claim.
Claims are checked for codes, modifiers, and NDCs, then submitted as a clean claim.
Denials are flagged and reworked; reimbursement is tracked to reconciliation.
We automate the pieces of the billing workflow that can be time-consuming: cleaning and checking the claims, tracking and managing denials and reconciliations.
Predict out-of-pocket costs before the encounter.
Manage the full claim lifecycle, from intake to reimbursement.
Built-in coding logic simplifies billing for clinical encounters.
Real-time visibility and hands-off denials management.
Monitor financial performance across stores, services, and payers.
Practical guides on medical billing, flu-season reimbursement, and getting paid for the care you deliver.
How the program works and how pharmacies can benefit from the funding.
Read the article →How rural pharmacies can qualify, apply, and get grant-ready with MedMe.
Read the article →How pharmacies join provider partnerships and build grant-ready clinical workflows.
Read the article →The questions pharmacy owners ask us most about how medical billing maximizes revenue in flu season.
Pharmacy revenue cycle management is the full process of getting paid for the clinical services you deliver, from credentialing and eligibility through coding, claim submission, denial management, and reconciliation. Dispensing settles instantly at the counter; clinical services run on a medical-billing workflow, and RCM is how you keep that workflow clean, complete, and collecting.
The pharmacy benefit covers dispensed prescriptions, adjudicated in real time at the point of sale. The medical benefit covers clinical services, vaccines, testing, consults, billed on a medical claim (CMS-1500 or 837P), the way a physician’s office bills. Most pharmacies bill only the first; clinical services often qualify for the second.
Yes. Medicare Part B covers seasonal flu vaccines and their administration at no cost-share to the patient, no deductible, no copay. Enrolled pharmacies bill Part B directly, using the flu product code plus G0008 for the administration. Part B, not Part D, is the correct rail for flu, pneumococcal, and COVID vaccines.
Yes. Beyond the pharmacy benefit you already run at the counter, most vaccines can be billed under the patient’s medical benefit, the way a clinic bills, through Medicare Part B, Medicaid, and many commercial plans. It takes payer enrollment and clean claims, but it opens a revenue stream most pharmacies leave on the table.
For most payers, flu shot administration is billed with CPT 90471 (and 90472 for each additional vaccine given the same day). Medicare Part B is the exception, it uses HCPCS G0008 for administration. The flu product has its own code that varies by formulation, so you bill both the vaccine and its administration. Confirm the current code set each season.
California carves the vaccine benefit into Medi-Cal Rx. Enroll as a Medi-Cal Rx provider, then submit the vaccine and its administration as a pharmacy claim; for Vaccines for Children (VFC) stock, you bill the administration fee. Pharmacist authority to administer is set by AB 144 and AB 1503, worth confirming the current rules before you bill.
Yes. NC Medicaid Direct reimburses pharmacists for non-VFC seasonal flu vaccines, and gives you two ways to bill: at the point of sale as a pharmacy claim, or on a medical claim (837P / CMS-1500). For patients 19 and older on the medical claim, append the CG modifier to the vaccine and administration codes and include the NDC. NCTracks is the claims system.
Washington was the first state to require commercial health plans to include pharmacists in their provider networks (SB 5557, phased in 2016 to 2017), effectively giving pharmacists provider status with those plans. To bill a commercial plan, credential and contract with it like any medical provider, then submit medical claims using standard billing codes. Medicaid is a separate track: enroll in Apple Health through ProviderOne to bill the state program.
Colorado pharmacists can bill Health First Colorado for immunizations. Because HB 18-1313 recognizes pharmacists as practitioners, you enroll as a provider, then bill the vaccine and its administration following the state’s Immunizations Billing Manual. Verify the current covered codes and rates in the manual before you submit, the state updates them periodically.