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)
A2. Do out-of-state payers know about the 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.
A4. 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.
A6. 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.
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?
For each administered vaccine, you must now submit two forms, or two electronic submissions, to the appropriate health plan, insurance company, or TPA:
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.
- The usual HCFA 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 costs.)
- A second HCFA 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.
D3. How do we fill in Box 31, “Signature of Physician or Supplier?”
It is most helpful to the WVA if you 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 be able to follow up with your office to obtain the needed item so WVA can receive payment.
D4. How does the DBA process work with the electronic form?
If you already submit electronically or are converting to electronic forms, 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:
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.
- 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:
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).
- 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
D10. 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 payers.
D11. How often will the WVA update its assessment grid?
The WVA’s goal is to have an annual update to the Assessment Grid. To ensure stability for providers and payers, the update will be effective at the beginning of a quarter. Beginning in 2015, the WVA plans to set the update for each July 1, following the CDC rate changes effective April 1. If unique circumstances arise, the Assessment Grid may be reviewed and updated more often than annually.
G3. How are the vaccines reported for patients who don't 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 the Childhood Vaccine Program. Complete the reporting requirements for the Childhood Vaccine Program through your regular vaccine accountability reporting process.
P1. What are the benefits of participating in the program?
There are many benefits of the state’s universal purchase system.
If you need help billing the Dosage Based Assessment, 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.
- You continue to receive vaccines for all of your patients less than 19 years of age at no charge, while giving your patients easy access to critical vaccinations.
- You avoid the financial and staffing burden required to purchase vaccines on your own.
- You don’t need to store vaccines separately for privately and federally covered children.
V1. What about childhood vaccines that aren’t 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 (ACIP). 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.