If you already submit electronically or are converting to electronic claims submission, please continue to do so. Simply submit the DBA information to the appropriate payer listing the WVA as the billing provider. The information should also contain:
- CPT code for the state-supplied vaccine — without modifiers
- Vaccine assessment charge found on the WVA Assessment Grid.
- WVA tax ID: 27-2251833
- WVA mailing address: P.O. Box 94002, Seattle, WA 98124-9402
Electronic billing requirements require the billing provider to fill in a physical address. However, to ensure that payments are sent directly to the secure WVA lockbox, please continue to use the WVA P.O. address for payment information.
- Fill in the “Pay-To Address” for the WVA with the WVA lockbox information: P.O. Box 94002, Seattle, WA 98124-9402 (Loop 2010AB)
- Fill in the “Billing Provider Address” for the WVA with the WVA physical address: Washington Vaccine Association, Marketplace Tower PH-A, 2025 First Avenue, Seattle, WA 98121
- WVA’s NPI #: 1699092718 (Loop 2010AA)
We advise you to notify your claim clearinghouse if you intend to submit the electronic form. You may also want to review our sample Electronic Form (PDF).