The Washington Vaccine Association enables the state to universally purchase childhood vaccines. The WVA collects funds from health insurers and TPAs (payers) via dosage-based assessment process and remits the funds to the state to cover the cost of vaccines for privately insured children. As a result, Washington is able to purchase vaccines for all children at volume rates from the US Centers for Disease Control and Prevention and deliver them to providers at no cost.
ASSESSMENT PAYERS (including TPA & Insurers)
What are the benefits of participating in the program for payers?
The Program assesses payers at rates that are lower than reimbursing the costs of private purchase of vaccines. In addition, payers are funding vaccines equitably and in proportion to their enrolled membership.
Do out-of-state payers know about the dosage-based assessment (DBA) billing process?
All major out-of-state plans are participating in the assessment process by using the DBA methodology. One of the benefits of the DBA methodology is to ensure that out-of-state insurers pay their fair share of the assessment charges for vaccines administered to Washington children.
Whose responsibility is it to make sure the DBA information reaches the payer and that payment reaches the WVA?
It is the provider's responsibility to complete the DBA process accurately to avoid denials. Once the forms reach the payer, it is the payer's responsibility to send payment to the WVA.
Who needs to register as a TPA and how often do I need to register?
Both state-based and out-of-state TPAs are required to register with the Washington Vaccine Association so we can keep you informed of the latest policies, changes, and reductions to vaccine charges. You only need to register once as long as your information is current. Your record can be modified by going to the registration page and entering your EIN.
How will I know that my registration was received correctly in the system and is now effective?
Once a complete registration is submitted, you will receive a confirmation email sent to the email address submitted (you will also receive a confirmation email when you make changes to your registration.) In addition, you can check what has been entered by entering your EIN on the registration page and the current entry will be displayed.
Does the WVA resell vaccines?
No. The WVA collects funds from private insurers operating in Washington State and remits all monies to the Department of Health to replenish the vaccine supply.
What are the benefits of participating in the program?
There are many benefits of the state’s universal purchase system:
Providers, at now charge, continue to receive vaccines for all of their patients less than 19 years of age, which provides patients easy access to critical
- Providers avoid the financial, storage, and staffing burden required to purchase vaccines on their
- Providers are not required to store vaccines separately for privately and federally covered
If you need help billing the Dosage-Based Assessment (DBA), please contact us at firstname.lastname@example.org or 1-888-928-2224. Finally, according to the state statute that created the Washington Vaccine Association, payers can deny claims for privately purchased vaccines.
Do providers need to continue filling out the vaccine reports for Public Health, in addition to completing the DBA?
Yes. Providers must meet all requirements of the Childhood Vaccine Program and continue to submit accountability reports according to their Provider Agreement.
Do providers need to put vaccines for privately insured children in a different refrigerator from federally funded vaccines?
No, you do not need to separate your vaccines. This is one of the benefits of maintaining the universal purchase system.
Do providers need to screen for VFC eligibility?
Yes. VFC status screening is still a federal requirement for every visit and has not changed. More information about VFC status screening, including frequently asked questions, is available here.
Do we still need to report vaccine usage by age group, or will the WVA gather that data?
Reporting vaccines by age group is a federal requirement for the state Department of Health’s Childhood Vaccine Program, so you need to continue providing the data. The reports capture data for vaccines administered to all children, not just those with insurance.
What kind of auditing process can we expect?
Health plans monitor their own claim systems to make sure they receive DBA forms from the WVA that correspond to vaccine administration claims from providers.
Will providers receive notification when WVA receives assessments from insurers?
No, you will not receive notification, but the DBA should not show up as accounts receivable in your practice management system. You are not responsible for ensuring that the WVA receives assessments for the vaccines you administer and document through the DBA process.
What actions should Washington providers take when administering vaccines to children who are Idaho residents?
Both the Idaho and Washington state departments of health have agreed that providers should be able to administer state-supplied vaccines without worrying about the residency of their patients. The two departments simply ask that you use your own state’s protocol for administered vaccines.
Do providers have a choice of vaccine brands?
Yes, providers now have the opportunity to change brands two times a year through the online vaccine selection process.
Are the requirements for providers compliant with HIPAA requirements?
Yes. As a business partner, the WVA must comply with HIPAA regulations and you do not need a Business Associates Agreement with the WVA.
Can patients who want to keep their vaccinations confidential (e.g., for HPV) opt out of having the insurer billed so their family or guardian do not find out?
All health plans are required to follow HIPAA guidelines when sending sensitive materials to members. You may want to advise patients to contact their health plans to find out what measures can be taken to protect their privacy in such situations.
What about childhood vaccines that are not listed on the WVA Assessment Grid?
The assessment grid now includes all the childhood vaccines routinely recommended by the federal Advisory Committee on Immunization Practices (CIP). Other vaccines not included in the DBA process may be available from the state department of health under the Childhood Vaccine Program For a complete list of all vaccines available through the Childhood Vaccine Program, please click here.
How are vaccines added to the Assessment Grid?
Generally, vaccines will be added when the following information is available: FDA approval, coding availability, vaccine availability, and pricing information.
Dosage Based Assessment (DBA) Billing
DOSAGE-BASED ASSESSMENT BILLING
How does my office need to bill to ensure that payers are responsible for the cost of state supplied vaccines that we provide to children with private insurance?
For each administered vaccine, you must now submit two forms, or two electronic submissions, to the appropriate health plan, insurance company, or TPA:
- The usual CMS 1500 form for the administration of the vaccine, office visit, and other charges, just as you always have, but without the vaccine codes and modifiers. (The payer reimburses you directly for these )
- A second CMS 1500 form that contains the vaccine codes, the dosage-based assessment (DBA) charges, which you’ll find on the WVA Assessment Grid, and our tax ID number: 27-2251833. You may want to review the DBA Form Sample.
The payer reimburses you for vaccine administration and office charges and pays the WVA for the state-supplied vaccine. We then transfer the funds to the state to continue purchasing the vaccines.
Where does the NPI number go on the dosage-based assessment (DBA) when submitted on a Form CMS 1500?
We suggest putting the WVA NPI (1699092718) in both boxes 24J and 33A, and the provider's NPI in box 32A.
How is Box 31, “Signature of Physician or Supplier” completed?
Please include the name of the individual provider who administered the vaccine in Box 31. That way if a claim is denied due to missing information, WVA may follow up with your office to obtain the needed information to ensure WVA receives payment.
How does the DBA process work with the electronic claim submission?
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
- Fill in the "Billing Provider Address" for the WVA with the WVA physical address: Washington Vaccine Association, 2025 First Avenue, Seattle, WA 98121
- WVA's NPI #: 1699092718
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 (Excel).
Do you have sample forms I can look at?
Yes. Here are the forms and charts that can help you:
Completed samples of the two forms required for the dosage-based assessment (DBA) process.
Spreadsheet that shows the fields and data for the electronic form format.
Chart listing the dosage-based assessment charges for vaccines covered by the state’s Childhood Vaccine Program.
Whose responsibility is it to make sure the DBA information reaches the payer and that payment reaches the WVA?
It is the provider's responsibility to complete the DBA process accurately to avoid denials. Once the forms reach the payer, it is the payer's responsibility to send the assessment to the WVA.
Do I use the DBA process for billing when a patient has primary insurance from a private insurer and secondary insurance from the state?
If you normally bill the state insurance plan or the Health Care Authority (HCA) for the vaccine, continue to do so. If you normally bill the private insurance carrier, use the DBA process.
If a payer denies our administration charges and we are resubmitting the claim, do we bill the payer again for the WVA?
In situations where you would rebill for yourself you would also rebill for the WVA. For example, if your administration claim is denied for missing information such as lack of correct member ID or birthdate, you should re-submit the WVA claim at the same time you re-submit the administration claim so the WVA can receive payment.
We bill through a clearinghouse. What if a claim scrubber rejects our submissions 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. If you run into problems, contact us at email@example.com.
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 different methods based on how well they addressed the concerns of providers, payers, the state Department of Health, and the Centers for Disease Control (CDC). The DBA methodology was the only one that could:
- Replicate processes that providers and payers already had in place, and
- Capture assessments from out-of-state
How often will the WVA update its assessment grid?
The WVA updates the WVA Assessment Grid annually and it is effective July 1, following CDC rate changes effective April 1. If unique situations arise, the WVA Assessment Grid may be reviewed and update more often than annually.
Does the WVA impact the federally funded Vaccines for Children (VFC) program?
No. Neither the federally funded Vaccines for Children Program entitlement, nor the state’s purchase of vaccines for children in state-sponsored medical plans are affected by the WVA.
How does the WVA process effect Medicaid and Medicaid managed-care plans?
There should be no change in the way you bill or work with Medicaid and Medicaid managed- care plans for children covered by those plans.
How are the vaccines reported for patients who do not have insurance?
DBA forms are not required for uninsured children. Bill those patients for services as you usually do, providing vaccines at no cost through Washington’s Childhood Vaccine Program. Complete the reporting requirements for the Childhood Vaccine Program through your regular vaccine accountability reporting process.