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 universal vaccine program requires payer payment to the WVA regardless of contractual status between the payer and the provider. Additionally, the WVA is not required to be in network with the payer. This means that a provider will bill the payer via the DBA process with the WVA as the pay-to billable provider.

It is highly possible that payer adjudication systems will filter out and reject non-network providers, whether rendering, or billable, on the DBA submission. Providers can assist in the DBA submission process by reviewing the following WVA Private Insurance Assessment Billing Provider & Payer Guide (pgs. 3 & 4) for vaccine material assessment and adding a notation on DBA claims as follows: for paper billing, in Box 19 “WVA does not need to be in network for grid payment”, or electronically the same phrase in loop 2300, seg./element NTE01, qualifier Add.

It will also assist the payer to process the DBA correctly if providers be sure to include the WVA taxonomy code (251K00000X) as follows:  for paper billing, in Box 33b, or electronically in loop 2000a, seg./element PRV02, qualifier PXC.

To be proactive, the WVA suggests the provider reach out to their payer representative(s) to confirm they are prepared to recognize and process the DBAs correctly.