WVA Glossary of Terms
Administration claim: Part of the two form dosage-based assessment (DBA) process for state-supplied childhood vaccines. This claim uses the HCFA 1500 form to document the provider's charge for administering the vaccine, the office visit, and other related costs.
Advisory Committee on Immunization Practice (ACIP): Federal advisory committee of immunization experts who advise the Secretary of the U. S. Department of Health and Human Services, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases. Committee recommendations include ages for vaccine administration, number of doses and dosing intervals, and precautions and contra-indications.
Auto-adjudicate (for claims): To automatically validate claims data and authorize payment in a computerized claims processing system without human intervention.
CDC: See “Centers for Disease Control and Prevention.”
Centers for Disease Control and Prevention (CDC): A federal agency in the U.S. Department of Health and Human Services that works to protect public health and safety through prevention controls for infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. The CDC manages the Vaccine for Children (VFC) entitlement program and works with VFC grantees to administer the program. The Washington State Department of Health buys childhood vaccines through the CDC for the state’s Childhood Vaccine Program.
CHILD Profile: The Washington State Department of Health's Health Promotion and Immunization Registry system, designed to help the state's children receive the preventive health care they need. The web-based Immunization Registry helps health care providers track immunizations for patients of all ages. CHILD Profile Health Promotion mailings provide age-specific health and safety information, including reminders for well-child check-ups and immunizations. The mailings are sent to parents beginning with the birth of their child to age six.
Childhood Vaccine Program: The official name of Washington State’s universal purchase program for childhood vaccines. The Department of Health purchases all ACIP-recommended vaccines for children and distributes them to physicians, clinics, hospitals, and other providers at no charge. State-supplied vaccines are available to all children in the state who are under age19.
Centers for Medicare and Medicaid Services (CMS): A federal agency in the U.S. Department of Health and Human Services (DHHS) that, among other responsibilities, administers Medicare and works with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and HIPAA standards.
CPT code: Abbreviation for Current Procedural Terminology (CPT) code, one of the many sets of medical billing codes that providers use for claim forms.
DBA: See “Dosage-based assessment."
DOH: See Washington State Department of Health.
Dosage-based assessment (DBA): In the context of the Washington Vaccine Association, the assessment to health plans, insurance carriers, third-party administrators, and other payers for one dose of a state-supplied vaccine that was given to a child who has private health insurance and is under age 19.
EOB: Acronym for the Explanation of Benefits, a summary of health care services administered to a health plan member. The EOB breaks out the portion of the cost covered by the plan and the portion that is the responsibility of the patient.
HIPAA: Acronym for the Health Insurance Portability and Accountability Act. The act sets standards for electronic health care transactions, patient privacy, and the security of health data.
HCFA: Health Care Financing Administration, the former name of the Centers for Medicare and Medicaid Services (CMS).
HCFA 1500 form: The standard health claim form used by providers to document and bill for services rendered to their patients. The form is widely accepted by insurance companies and is sometimes referred to as the “universal claim form.”
Local Health Jurisdiction (LHJ): One of 35 local health departments or districts in Washington State. Among other responsibilities, these government agencies work with providers in ordering vaccines through the Childhood Vaccine Program and conduct quality assurance for immunization programs. For a map of the state's LHJs, please visit the Department of Health's web site.
NPI: Acronym for national provider identifier, a HIPAA standard that assigns a unique identification number for covered health care providers.
Payers: Health plans, health insurance carriers, and third-party administrators who pay claims submitted by patients, or by providers on behalf of patients. In Washington State, payers also remit funds to the Washington Vaccine Association to cover the dosage-based assessment charge for each state-supplied vaccine administered to a child under age 19.
Provider: Physicians, nurses, clinics, hospitals, and other individuals and organizations who provide health care services to patients, such as administering vaccines to children.
Taft-Hartley Trust: Multi-employer health plans whose funds and assets are placed in a trust for employees and their families and managed by a board of trustees. Because of their centralized administration and resource pooling, these plans are the only way that some small employers can afford to provide comprehensive health coverage to their employees.
Third-party Administrator (TPA): In the context of health care, an organization that provides administrative services, such as claims processing and adjudication, member enrollment, and payment to health care providers, for companies that offer health benefits to their employees or members (sometimes called plan sponsors). Although a TPA is often referred to as a “payer” in the health care system, TPAs actually process payments using the plan sponsor’s funds
Underinsured: In the context of the federally funded Vaccines for Children (VFC) program:
- A child with private health insurance that doesn’t cover vaccines
- A child whose insurance covers only selected vaccines (making the child VFC-eligible for the vaccines not covered)
- A child whose insurance caps vaccine coverage at a certain amount after that amount has been reached.
Universal Purchase: The purchase of vaccines for all children under age 19 by a state, urban, or territorial public immunization program. The Washington State Department of Health’s Childhood Vaccine Program is one such universal purchase program.
Vaccine Assessment: See “Dosage-based assessment”
Vaccines for Children (VFC): A federally funded entitlement program run by the Centers for Disease Control and Prevention (CDC) that purchases and distributes all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). The vaccines are provided at no cost to children who meet the eligibility requirements: enrolled in Medicaid, uninsured, underinsured, Native American, or Alaska Native. In Washington, the VFC program is administered by the Washington State Department of Health.
VFC Status Screening: A requirement of the federal Vaccines for Children (VFC) program. At every immunization visit, the provider must document the child’s VFC status as uninsured, underinsured, American Indian or Alaska Native, or enrolled in Medicaid. For more information about VFC status screening, please visit the Department of Health's web site. link embedded
Washington State Department of Health: Administers the Washington State Childhood Vaccine Program and the federal Vaccines for Children (VFC) program for the state. Through its Childhood Vaccine Program, the department purchases ACIP-recommended vaccines for all children and distributes them to providers at no charge. The department is also responsible for ensuring that providers and others meet federal VFC requirements, including VFC status screening and immunization quality standards.
Washington Vaccine Association (WVA): Formed by the Washington State legislation in March 2010 to enable the state to continue universal purchase of vaccines for children under age 19. As an independent, nonprofit organization, the WVA administers the flow of vaccine funds by collecting payments from health plans, insurance companies, and other payers and remitting the funds to the state.