| | | Dosage Based Assessments, How to
Many questions to WVA have been related to how to file Dosage Based Assessment Claims. We have put together these resources in one place to help answer these questions.
If you have further questions please email them to info@wavaccine.org.
Dosage Based Assessment, How to
A six minute presentation describing how to file using the new method.
Click here for video high speed connection or low speed connection.
Washington Vaccine Association Assessment Grid
The grid with costs for covered vaccines. Available in PDF or Excel.
Electronic Claim Mapping Spreadsheet
This spreadsheet shows the fields and data when using the 837 based electronic claim format. Available in Excel.
Form Review
The pages used in the How to presentation above. Available in PDF.
Sample DBA Form
A sample of the Form 1500 filled out as a Dosage Based Assessment Form. Available in PDF.
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