Resources

Enrolled providers can submit an online vaccine order request weekly. The deadline to submit requests each week is 5 p.m. Wednesday. Orders approved ship the following week. Providers will receive an automated response that the order request has been received. An email confirmation will be sent if an order is placed on the provider's behalf. Please do not send multiple order requests within the same week.

It is acceptable and encouraged to submit a new order request for each week that your facility desires vaccines. Order requests that are not fulfilled will not be held over week to week. The State’s ability to fill vaccine order requests is contingent on vaccine supply. The submission of an order request does not guarantee an order will be filled.

Submit a redistribution request form. Please allow 24 business hours for redistribution requests to be processed and approved. All requests must be approved prior to the redistribution of COVID-19 vaccines.

In order to request to transfer vaccine from your location to another, a redistribution agreement must first be in place.

When transferring vaccine, make sure you are also transferring the ancillary kits. Only unopened vaccines should be transferred. No open vials or partial doses in syringes should be transferred. Transferring of inventory must be documented in ShowMeVax in the On Hand Inventory Module by clicking on Action, then Transfer.

Further questions should be directed to covidvaccineredistribution@health.mo.gov.

No. Effective February 19, 2021, only Missouri residents are eligible to receive the vaccine from their Missouri-based primary care providers. These doses are provided to these Missouri-based providers from the state of Missouri’s allocation from the federal government. The federal government allocates vaccine to each state based on population, and so each state’s allocation reflects their own population. Non-Missouri residents must seek their vaccine in their home state.

Missouri vaccinators must complete any vaccinations for non-Missouri residents that were scheduled before February 19, 2021 no later than March 1, 2021. Missouri-based vaccinators may not schedule new vaccinations with non-residents.

Yes, in certain situations. As noted in DHSS’s COVID-19 Vaccinator - Residency Status Guidance effective February 19, 2021, certain employers may arrange a vaccination clinic on site for their employees. It is assumed that these vaccination events are generally directed to a specific population at the facility, rather than the general public. In order to reduce the complexity of these situations, the state understands that non-Missourians may be included in these vaccination events. Vaccinators may vaccinate the population at these locations, regardless of a person’s residency status. Adherence to the state’s priority phases is required. Thus, providers may vaccinate non-residents in conjunction with an employer-coordinated vaccine clinic. Providers may not, however, vaccinate non-residents who present themselves independently seeking vaccination due to their employment status.

Yes.

• Confirmation email: For each first dose shipment, there is a matching second dose shipment. Before providers receive a shipment of vaccine, they first receive a confirmation email from DHSS. This email informs providers if they are receiving a first dose, or if the upcoming shipment is the matching second dose to a provider’s previous order.
  • Subject line – The subject line of the email will indicate if it’s a first or second dose shipment
  • Body of the email – In the email, DHSS will tell you if this is a first or second dose shipment
• Arrival date: Recall that the State places the booster order on your behalf—no action is required by you. The second dose shipment for Pfizer usually ships 14 days after the receipt of the first dose shipment. The second dose shipment for Moderna is usually sent 21 days after the receipt of the first dose shipment. Second dose shipments usually arrive on Thursdays. First dose shipments usually arrive on Tuesdays. Thus, if you’re receiving doses on Thursday, they are most likely second doses.
• Your internal systems: In addition to all DHSS does to help you distinguish first from second dose, we encourage you to speak with your peers around the State to understand how their systems demarcate first and second dose orders.

If you are unsure about your shipment, please refer to the confirmation email provided by DHSS to the Primary and Back-Up Vaccine Coordinator. Providers can also email the DHSS COVID-19 Vaccine Orders covidvaccineorders@health.mo.gov with the following subject line:

• “(Provider Pin) Assistance needed: 1st or 2nd dose”

Prevention

Before we provide guidance about what to do with an unclaimed booster, we believe it’s productive to discuss how to prevent the problem from ever arising. Best practices from vaccinators around the state show how we can limit the amount of unclaimed second dose shots:

• Making the most of the first shot – Vaccinators should schedule the booster appointment before the patient leaves, and should collect multiple piece of contact information. Patients should receive a direct line they can contact if they have questions. In sum, “time, place, and process”—when they will get their second dose, where they will get it, and how.
• Reminding the patient before – At minimum, patients should receive at least one reminder. If possible, the state encourages multiple touch points in between the first and second dose. Two-way communication always trumps one-way, and if the patient responds that will increase the likelihood they will return.
• Guiding the patient the day of – Vaccinators should remind the patient on the day of the patient’s appointment and establish a direct line of communication for the patient to reach out with questions or concerns. If life gets in the way, patients should know how to reschedule. In the event the patient misses their appointment, vaccinators should reach out and attempt to make contact to reschedule.
• Reaching out one last time – In the unfortunate event a patient misses their appointment and does not communicate why, vaccinators should again reach out the next day, leaving specific guidance about the timeline to reschedule and the implications of not rescheduling. If the provide doesn’t hear back within 24 hours—so two full days after the scheduled appointment—that vaccine is now available for alternative use.

Understanding the problem of using booster doses as primes

In addition to no-shows for second dose appointments, we also hear of vaccinators extracting a seventh dose from Pfizer vials and administering them. Both of these situations can cause “unmatched” doses—meaning, an intended second dose becomes a prime for someone new. The issue with “unmatched” doses is that a booster dose—so a second-dose shipment of vaccine—used as a first dose will not have another shipment, meaning the person who receives that booster as a prime now does not have a matching vaccine.

Following-up with the State after administering a booster as a prime

After making every effort to prevent using a booster as a prime, we realize situations will still arise. The state cannot guarantee we will be able to provide you a matching dose; however, we will make every effort on your behalf. Here’s what we need you to do:

• Weekly email on Monday mornings: If you used a booster as a prime and now need a matching vaccine, please send consolidate your request and submit an email on Monday mornings by 9:00 a.m. to covidvaccineorders@health.mo.gov.
• Subject line – The subject line should read “(Provider Pin) Unmatched Vaccine Assistance”
• Content required – We will need to know what kind of vaccine, how many, and when you need them by.

Due to minimum orders and severely limited supply, the state cannot guarantee vaccine. Please make every effort to prevent unmatched doses.

In this case, a vaccinator mistakenly administered large number of boosters as primes. This creates a need for matching vaccines. In short, the State cannot assist in these cases due to supply constraints and a commitment to equitable distribution. In the event a vaccinator administers a large number of boosters as primes, they will need to solve the problem internally.

Fully vaccinated individuals who are exposed to COVID-19 do not need to quarantine if they:

• Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine);
• Are within 3 months following receipt of the last dose in the series; and
• Have remained asymptomatic since the current COVID-19 exposure.

Persons who do not meet all three of the above criteria should continue to follow current quarantine guidance after exposure to someone with suspected or confirmed COVID-19. If symptoms start to develop, the individual should start isolating.

While we have many various groups that wish to assist by serving as vaccinators, ensuring only appropriate access to HIPAA-protected information is of paramount importance. While there may be a few limited circumstances in which these arrangements with external partners may be the appropriate course of action, generally, DHSS will be working with Regional Implementation Teams, LPHAs, health care providers and pharmacies for the purpose of registering as vaccinators. Generally, these groups will be the only ones that may have access to or register as ShowMeVax providers.

Second dose orders are automatically placed on your behalf by the State. If you received Dose #1 by means of redistribution from another provider, the same will need to happen with Dose #2.

Yes, with the following conditions:

• Storing site must be an enrolled COVID-19 Vaccine Provider
• Storing site must be less than 10 miles away from the site of the original provider. This statement is only referring to storage and is not intended to limit redistribution efforts with mileage limits.
• Storing site must provide daily temperature logs to original provider
• Provider must use vaccine within 10 days of receipt
  • All inventory must be entered into SMV and reported to Vaccine Finder daily
  • Vaccine administration must be reported within 24 hours of dose administration
• All other requirements listed in the COVID-19 Provider Agreement must be honored

The COVID-19 vaccination provider agreement states that the provider must dispose of wasted COVID-19 vaccines according to the state’s procedures. Sites should dispose of COVID-19 vaccine waste in accordance with local regulations and processes they are currently using to dispose of regulated medical waste. In addition, COVID-19 vaccine program requirements include providers reporting wastage (e.g., unused, spoiled, or expired) information according to the ShowMeVax system.

To report wastage, such as drawn but not administered, diluted but not administered, etc, go to the location’s On Hand Inventory and find the lot number of the vaccine. Click on Action, then Adjustment. In the Reason box, please select one of the VtrkS options for reasons that best describes the situation. Enter the number of doses you are wasting and enter any comments necessary. Then click on the green Create button.

To report a return, such as expired or spoiled due to temperature excursion, go to Inventory, then Vaccines, then Vaccine Return. Click on the green ‘Add New Vaccine Return’ button at the top of the screen and then select the location where the vaccine is located, then select Next. You will then be able to fill out the return request based on the vaccine in your location’s inventory. Once completed, click on the green “Create” button. Information will be sent to our Support Team for processing. You will receive additional information via email as well as a return shipping label to return the vaccine to the manufacturer.

Please contact the support team at vfc-smvsupport@health.mo.gov should you have questions on how to process wastage and/or return.

Vaccine Finder - Federal requirement-Daily Reporting Required
What is it? A CDC requirement mandatory for all COVID vaccinators today

• What is required? Update vaccine inventory in VaccineFinder each day no later than midnight local time (federal requirement)
  • Mandate: Inventory reporting to CDC required for all vaccinators beginning upon receipt of first vaccine shipment or receipt of redistributed vaccine. Public Reporting of vaccine location optional at this point.
  • Overview
  • Factsheet
  • Provider resources
• VaccineFinder Support number: 1-855-886-4317

How will I be notified? After you enroll as a COVID provider in ShowMeVax (SMV) an email to create an account to complete the registration will be sent to the provider organization's email address submitted in the provider enrollment form. The email will be from vaccinefinder@auth.castlighthealth.com.

• Do you know who is listed for your organization?
  • Please also check spam/junk folders for this email.
  • This is a personalized link that will expire in 7 days.

What if I haven't been notified? If you do not receive an email and have received vaccine, please email eocevent522@cdc.gov for registration assistance. You should send an email here for assistance if your link has expired.

For technical assistance with account log-in problems, password resets, file upload errors, etc. please email vaccinefinder@castlighthealth.com.

ShowMeVax (SMV) - State requirement-Weekly/Monthly Reporting Required

What is it? State system that helps us monitor and help redistribute vaccines to those who need them the most. We can only do this if the inventories we use to plan are accurate. That's why we need your help!

Where can I find out more? Provider resources are available in the Report Module in the Missouri Forms and Document section. You can also reach out to vfc-smvsupport@health.mo.gov

What do I need to do? Upon receipt of vaccine (direct ship or redistribution) log into SMV and add the inventory to your on-hand inventory. Log into SMV, go to Inventory>Vaccines>On Hand. Look for a blue link at top of page regarding shipments/transfers. Click on blue link and verify if shipment has been received. Click on Receive and the doses will populate over to your on hand inventory. If you do not see a blue link, you will need to add manually. Directions for this process are located in the 'Reports' section of SMV, under 'Missouri Forms and Documents' --> 'Adding Vaccine Inventory'.

What if I received vaccine through a redistribution? Redistributed vaccine must be documented in SMV. Here's how:

• The sending facility will create an 'Adjustment' in the On Hand Inventory as a 'Transfer' to the receiving facility.
• The receiving facility will accept the transfer by clicking on the blue link located at the top of the page in the On Hand Inventory module.

How do I reconcile/report my inventory on a weekly basis in SMV? You can reconcile/report in two ways: DO NOT ENTER ‘ADJUSTMENTS’ (SUBTRACT DOSES) FROM YOUR ON HAND INVENTORY. THIS IS NOT THE PROPER WAY TO RECONCILE INVENTORY.

• Manual entry - Please refer to the 'User Guide' in the 'Report module'
• Auto-decrementing for HL7 Interface Users - Please refer to the 'User Guide' in the 'Report' module

Inventory reporting is required to ensure you are eligible to receive additional orders/shipments of vaccine. Failure to report could cause failure to receive vaccine.

Vaccinators are required to report all vaccinations in ShowMeVax and VaccineFinder within 24 hours (with a 72-hour grace period to start). This information is critical for us to monitor supply and vaccination levels around the state.

There are several options available to providers for transmitting the required data elements of the COVID-19 vaccination to ShowMeVax:

• HL7 Interface
• HL7 Batch Upload
• Manual Entry through the ShowMeVax portal

Please know that if your organization is not documenting priority population administration in your electronic health record or utilizing a hub, an HL7 batch upload or manual entry are your options for populating ShowMeVax. If your organization is not utilizing an electronic health record or hub, manual entry is your only option for populating ShowMeVax.

Please communicate your strategy for transmitting vaccinations to ShowMeVax to the Reporting Team at immunizationhl7onboarding@health.mo.gov. Once registered, the Reporting Team will provide the appropriate implementation guides and how-to procedures. It is important to test your documentation option with the Reporting Team prior to your first vaccination. Thank you for your diligence in reporting this information.

Please ensure staff are verifying patient and dose information before submitting the dose documentation. (For example, ensure the correct administration date is listed in the patient record/HL7 message).

For more information about VaccineFinder enrollment, please visit their website.

• Providers with an electronic medical record system actively submit immunizations to ShowMeVax via an HL7 message. Do not manually enter into ShowMeVax;
• Providers with an electronic medical record system and not currently submitting to ShowMeVax must manually enter immunizations into ShowMeVax. There are two options:
  • IZ Quick Add method –Does not deduct from current vaccine inventory; Inventory will not be updated, until a reconciliation is completed by manually reporting total doses administered and total doses currently on hand;
  • Enter immunizations using the Patient Module. Search for patient. Click on arrow beside “Demographics” and select “Immunizations”. Click on ‘Select Action” arrow and click on “Add Administered”. You will be able to add the vaccines administered and the ability to select the vaccine information from your on hand inventory. This will then deduct the dose from the on hand inventory.

A COVID Administrator user has been added as a drop down option for vaccine administrator. Please use this option when temporary staff or outside resources are being utilized to assist with vaccination efforts. You will still need to have the actual name of the person and their signature on all paper and electronic consents for vaccination.

Instruction guides are also available within ShowMeVax in the Report Module under Missouri Forms and Documents.

If an error occurs during the administration of a vaccine dose, vaccinators should:

• Inform the recipient of the vaccine administration error.
• Consult with the state immunization program and/or Immunization Information System (IIS) to determine how the dose should be entered into the IIS, both as an administered dose and to account for inventory.
• Report the error to the Vaccine Adverse Event Reporting System (VAERS), unless otherwise indicated in the table. Providers are required to report all COVID-19 vaccine administration errors—even those not associated with an adverse event — to the VAERS. To file an electronic report, please see the VAERS website external icon.
• Determine how the error occurred and implement strategies to prevent it from happening again. A discussion on strategies to prevent errors can be found in the Vaccine Administration chapter of the Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book). Additional resources can be found on CDC’s vaccine administration web page, including a job aid for preventing errors.

For a list of errors and their interim recommendation, click here

Vaccinators must document temperatures for each storage unit that maintains COVID-19 vaccine. However, providers are not required to report or upload their temperatures in ShowMeVax. A paper temperature log can be maintained on site and available for review upon request. A temperature log template is available in ShowMeVax in the Report module under Missouri Forms and Documents. VFC Providers must still report their temperatures in ShowMeVax.

After the Pfizer vaccine shipment arrives you will receive an email from Controlant©. If the shipper will not be used to store vaccine you will need to respond to the email to opt of this program.

If your organization has a firewall that blocks access to the activation link you will need to follow the steps below:

1. Open Google Chrome (do not use another browser)
2. Go to: https://usg.bi.controlant.info/account/login
3. Use the username and password provided in the email
4. You will be directed to the Controlant dashboard and asked to reset your password

Providers are required to report adverse effects as quickly as possible via VAERS.

The CDC has issued Interim Considerations for Preparing for the Potential Management of Anaphylaxis at COVID-19 Vaccination Sites. Appropriate medical treatment for severe allergic reactions must be immediately available in the event that an acute anaphylactic reaction occurs following administration of Pfizer-BioNTech COVID-19 vaccine.

Vaccination providers should also be reminded to review, implement, and consult CDC’s Interim Clinical Considerations for Use of Pfizer-BioNTech COVID-19 vaccine. All ACIP recommendations related to COVID-19 vaccine can be found at ACIP COVID-19 Vaccine Recommendations.

Providers may report any vaccine adverse event that occurs. Reports are reviewed daily and weekly by CDC to determine if follow-up is needed.

All organizations and providers participating in the CDC COVID-19 Vaccination Program:

• must administer COVID-19 Vaccine at no out-of-pocket cost to the recipient
• may not deny anyone vaccination based on the vaccine recipient’s coverage status or network status
• may not charge an office visit or other fee if COVID-19 vaccination is the sole medical service provided
• may not require additional medical services to receive COVID-19 vaccination
• may seek appropriate reimbursement from a program or plan that covers COVID-19 Vaccine administration fees for the vaccine recipient, such as:
• vaccine recipient’s private insurance company
• Medicare or Medicaid reimbursement
• HRSA COVID-19 Uninsured Program for non-insured vaccine recipients
• may not seek any reimbursement, including through balance billing, from the vaccine recipient

For additional information on filing claims for reimbursement of COVID-19 vaccine administration fees, go to:

• HRSA COVID-19 Uninsured Program
• CMS Guidance