No. The patient should be considered uninsured and vaccine material billed accordingly, outside of the WVA, DBA process. Health care sharing plans
If an insured patient under the age of 19 receives vaccine material obtained via the Washington State Childhood Vaccine Program but the provider and/or the WVA does not have a contract with the patient’s insurer and is considered out-of-network, how does the provider submit a Dosage-Based Assessment (DBA) for the vaccine material?
The WVA is defined as a Public Health & Welfare agency under the provider identification and billing taxonomy code 251K00000X. Washington State’s
If a payer denies our administration charges, do we submit the DBA again?
In situations where you would rebill for yourself you would also resubmit the DBA for the WVA. For example, if your administration claim is denied for
Is there a cap on the vaccine administration charge we can bill to the payer?
The DOH administration fee cap is found on Page 8, #6 of the DOH Provider Agreement: Enrollment Packet. This applies a $23.44 cap to all
We bill through a clearinghouse. What if our submissions are rejected because we used your federal tax ID and NPI numbers?
Please advise your clearinghouse that you’ll be using the DBA process, with our name, Tax ID, and NPI. Our Billing Guide has specific information for
How did you come up with the dosage-based assessment (DBA) methodology?
In the months leading up to the formation of the WVA by the state legislature, a multidisciplinary group of stakeholders evaluated a number of
Do you have sample forms I can look at?
DBA Form Sample (pdf) Completed samples of the two forms required for the dosage-based assessment (DBA) process. Electronic Form
Are there any changes to the dosage-based assessment (DBA) process in the new WVA Private Insurance Assessment Billing Provider & Payer Guide that provider offices should be aware of?
Yes. In the spring of 2020, changes were made to improve the DBA process to decrease errors and confusion at both the provider and payer levels.
When the WVA Assessment Grid Changes
The new pricing grid for WVA vaccine material is updated each July 1, and runs through June 30 of the following year. This requires updating of “fee