The Washington Vaccine Association enables the state to continue universal purchase of childhood vaccines. The WVA collects funds from health insurers and remits them 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 and deliver them to providers at no cost.
The FAQs are divided into five categories:
- "A" means questions related to Assessment Payers (Including TPAs & Insurers).
- "D" means questions related to Dosage-Based Assessment Billing.
- "G" means questions related to Government Programs.
- "P" means questions related to Providers.
- "V" means questions related to Vaccines.
ASSESSMENT PAYERS (Including TPAs & Insurers)
A1. What are the benefits of participating in the program for payers?
A2. Do out-of-state payers know about the DBA billing process?
A3. Whose responsibility is it to make sure the DBA information reaches the payer and that payment reaches the WVA?
A4. Who needs to register as a TPA and how often do I need to register?
A5. How will I know that my registration was received correctly in the system and is now effective?
A6. Does the WVA resell vaccines?
A7. How can I tell if my TPA information is current in WVA's system and how do I edit my record?
DOSAGE-BASED ASSESSMENT BILLING
D1. 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?
D2. Where do I put the NPI number on the DBA when submitted on a Form 1500?
D3. How do we fill in Box 31, “Signature of Physician or Supplier?”
D4. How does the DBA process work with the electronic form?
D5. Do you have sample forms I can look at?
D6. Whose responsibility is it to make sure the DBA information reaches the payer and that payment reaches the WVA?
D7. Do I use the DBA process for billing when a patient has primary insurance from a private insurer and secondary insurance from the state?
D8. If a payer denies our administration charges and we are resubmitting the claim, do we bill the payer again for the WVA?
D9. We bill through a clearinghouse. What if a claim scrubber rejects our submissions because we used your federal tax ID and NPI numbers?
D10. How did you come up with the dosage-based assessment (DBA) methodology?
D11. How often will the WVA update its assessment grid?
G1. Has the WVA changed anything for the federally funded Vaccines for Children (VFC)?
G2. How does this affect Medicaid and Medicaid managed-care plans?
G3. How are the vaccines reported for patients who don't have insurance?
P1. What are the benefits of participating in the program?
P2. Do providers need to continue filling out the vaccine reports for Public Health, in addition to completing the DBA?
P3. Do providers need to put vaccines for privately insured children in a different refrigerator from federally funded vaccines?
P4. Do providers need to screen for VFC eligibility?
P5. 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.
P6. What kind of auditing process can we expect?
P7. Will providers receive notification when WVA receives assessments from insurers?
P8. What actions should Washington providers take when administering vaccines to children who are Idaho residents?
P9. Do providers have a choice of vaccine brands?
P10. Are the requirements for providers compliant with HIPAA requirements?
P11. Don’t we have to have an agreement with you in accordance with HIPAA laws, since you receive patient information?
P12. Can patients who want to keep their vaccinations confidential (e.g., for HPV) opt out of having the insurer billed so their parents don’t find out?
V1. What about childhood vaccines that aren’t listed on the WVA Assessment Grid?
V2. How are vaccines added to the Assessment Grid?