FAQs

The WVA, is a not-for-profit organization that works in partnership with the Washington State Department of Health, to support the state’s universal Childhood Vaccine Program. The WVA facilitates the funding for vaccines administered to commercially insured children under age 19.

The CVP is a program that distributes recommended pediatric (children under 19) vaccines to providers at no cost to providers or patients.

The WVA ensures vaccine access to commercially insured children by collecting financial assessments from health insurers and third-party administrators for administered vaccines. These assessments, in turn, fund the discounted vaccine purchases by the Washington State Department of Health for the CVP.

The DBA is a financial charge (assessment) submitted by providers through the claims process to health insurers for state-supplied vaccines administered to commercially insured children. This ensures a funding stream to the WVA for the vaccines provided to commercially insured children.

Providers enrolled in the CVP and administer state-supplied vaccines to commercially insured children under age 19 must submit a DBA. The DBA is not required for uninsured, Medicaid, Apple Health, Tribal, under-insured served at FQHCs/RHCs, or CHIP-covered patients.

No, patients are not responsible for any portion of the DBA payment. The DBAs are submitted and processed without patient responsibility for vaccine costs.

No, where the DBA is an assessment, and not a medical claim, there is no timely filing limit for submission. Timely filing denial edits should be removed from the payer adjudication systems.

1. Enroll in the WA DOH Childhood Vaccine Program (CVP).
2. Set up electronic billing systems for DBAs.
3. Verify and document patient eligibility per DOH requirements for each visit.
4. Submit the Dosage Based Assessment (DBA) accurately to commercial insurers.

Providers need to contact their EMR/billing software vendor to ensure their billing systems and clearinghouse connections are:

1. Set up accurately to submit the DBAs, and
2. Updated annually with the correct CPT codes, NDC codes, and vaccine material amounts as per the WVA’s Vaccine Assessment Grid.

Guidance to EMR/Billing software vendors:

• All DBAs should be electronically submitted to the payer (health insurers and TPAs) using the 837 Professional format.
• DBAs should not be submitted directly to the WVA. The WVA’s Outpatient and Inpatient Billing Guides and supporting documents are available online.

Providers must correct any provider demographic, patient eligibility, or other errors, and then re-submit both the administration claim and DBA to the payer.

Note: If the administration claim is denied, providers should also assume denial of the DBA.

No. Do not include the vaccine codes on your administration claim as this will cause the payer to view the DBA as a duplicate claim and deny payment to the WVA.

The SL modifier is NOT used for vaccines funded by the WVA for privately insured children under the age of 19.

The SL modifier is only used for publicly funded vaccines under the federal vaccines for children (VFC) program and the WA state Medicaid CHIP program for children under the age 19 which includes Medicaid, CHIP, uninsured, underinsured, and American Indian/Alaska Native.

While these vaccines are purchased and supplied by the WA state Department of Health at no cost to the provider or the patient, the vaccines are privately funded due to the dosage-based assessments (DBAs) which are charged to private payers and paid to the WVA.

The SL modifier is only used for publicly funded vaccines under the federal vaccines for children (VFC) program and the WA state Medicaid CHIP program for children under the age 19 which includes Medicaid, CHIP, uninsured, underinsured, and American Indian/Alaska Native.

Yes, providers can administer vaccine materials that are still viable even if they have been discontinued from previous grids. If the CPT code is not on the current grid, providers should refer to the legacy information at the end of the document and remit the last published assessment amount on the Dosage-Based Assessment (DBA).

1. Understand the basics of the DBA process
2. Set up adjudication systems correctly.
3. Follow up on final details to ensure compliance with WVA’s guidelines.

To assist with this, the WVA has developed a Health Insurers & TPAs Compliance Guide.

1. Payers should reverse and adjust the payments.
2. Payers should review their systems to ensure the correct set up to avoid such errors.

Key requirements outlined in the WVA Health Insurers & TPAs Compliance Guide include:

• The full WVA Vaccine Assessment Grid amount is due to the WVA.
• There is no patient responsibility.
• There is no timely filing limitation for DBAs where they are a statutorily created assessment.
• There are no out-of-network (OON) denials.
• Working collaboratively with the WVA to resolve any denial or payment issues.
• Electronic Remittance Advices and ACH Payments are preferred.
• TPAs are required to register and maintain contact information on the WVA website.

Pursuant to RCW 70.290.075, if the clients represented by the TPA offer private health plan or self-funded employer plans that include vaccine material coverage to patients under the age of 19, both state-based and out-of-state TPAs are required to register with the WVA. TPAs are only required to register once.

• For DBA process inquiries contact the WVA at:
  • Email: info@wavaccine.org
  • Phone:1-888-928-2224

• For CVP enrollment and vaccine procurement questions, contact the WA DOH:
  • Email: WAChildhoodVaccines@doh.wa.gov
  • Phone: 360-236-2VAX

Health insurers and TPAs interested in electronic remittances and/or ACH payments can contact the WVA at EDI@wavaccine.org to set up these services.

Sign up for the WA DOH Vaccine Blurb email list by sending a request to WAChildhoodVaccines@doh.wa.gov.

For questions or assistance, you can contact the WVA at compliance@wavaccine.org.

The WVA’s Tax ID is 27-2251833 and the NPI is 1699092718.

The Grid contains the per dose assessment rate remitted by payers to the Washington Vaccine Association (WVA).

It includes:

• CPT code
• NDC code
• Vaccine trade name
• The assessment rate

Note: The assessment rate on the Grid amount should be submitted as the charged amount on the DBA.

The Grid is updated annually and is in effect from July 1 to June 30 of the following year.

There are sometimes off-cycle Grid changes, which will be communicated by both the WVA and the Washington State Department of Health.

Providers should verify the date of service to ensure the correct grid is used.

• Check the validity of the CPT code
• Ensure the correct assessment amount is submitted in the charges field and remitted to the WVA.

Note:  The WVA’s Outpatient and Inpatient Billing Guides and supporting documents are available online.

Yes, providers can administer vaccine materials that are still viable even if they have been discontinued from previous grids. If the CPT code is not on the current grid, providers should refer to the legacy information at the end of the document and remit the last published assessment amount on the Dosage-Based Assessment (DBA).

The legacy CPT and NDC codes are listed at the end of the WVA Vaccine Assessment Grid document for reference.