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Frequently Asked Questions


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:

  1. "A" means questions related to Assessment Payers (Including TPAs & Insurers).
  2. "D" means questions related to Dosage-Based Assessment Billing.
  3. "G" means questions related to Government Programs.
  4. "P" means questions related to Providers.
  5. "V" means questions related to Vaccines.

ASSESSMENT PAYERS (Including TPAs & Insurers)

Hide details for A1. What are the benefits of participating in the program for payers?A1. 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.
Hide details for A2. Do out-of-state payers know about the DBA billing process?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.
Hide details for A3. Whose responsibility is it to make sure the DBA information reaches the payer and that payment reaches the WVA? A3. 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.
Hide details for A4. Who needs to register as a TPA and how often do I need to register? 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.
Hide details for A5. How will I know that my registration was received correctly in the system and is now effective? A5. 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.
Hide details for A6. Does the WVA resell vaccines?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.

Hide details for A7. How can I tell if my TPA information is current in WVA's system and how do I edit my record?A7. How can I tell if my TPA information is current in WVA's system and how do I edit my record?
You can use your EIN on the registration page to retrieve your current record. Changes can then be made directly to the form and resubmitted. For security, an email is sent to the prior email address on file informing them that a change has been made.



DOSAGE-BASED ASSESSMENT BILLING
Hide details for 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?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 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.

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.
Hide details for D2. Where do I put the NPI number on the DBA when submitted on a Form 1500?D2. Where do I put the NPI number on the DBA when submitted on a Form 1500?
We suggest putting the WVA NPI in both boxes 24J and 33A, and the provider's NPI in box 32A.
Hide details for D3. How do we fill in Box 31, “Signature of Physician or Supplier?”  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.
Hide details for D4. How does the DBA process work with the electronic form? 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:
  • 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:

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).
Hide details for D5. Do you have sample forms I can look at?D5. Do you have sample forms I can look at?
Yes. Here are the forms and charts that can help you:

DBA Form Sample (pdf)
Completed samples of the two forms required for the dosage-based assessment (DBA) process.

Electronic Form (Excel)
Spreadsheet that shows the fields and data for the electronic form format.

Washington Vaccine Association Assessment Grid
Chart listing the dosage-based assessment charges for vaccines covered by the state’s Childhood Vaccine Program.
Hide details for D6. Whose responsibility is it to make sure the DBA information reaches the payer and that payment reaches the WVA?D6. 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.
Hide details for 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?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?
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.
Hide details for D8. If a payer denies our administration charges and we are resubmitting the claim, do we bill the payer again for the WVA? D8. 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.
Hide details for D9. We bill through a clearinghouse. What if a claim scrubber rejects our submissions because we used your federal tax ID and NPI numbers?D9. 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 info@wavaccine.org.
Hide details for D10. How did you come up with the dosage-based assessment (DBA) methodology?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.
Hide details for D11. How often will the WVA update its assessment grid?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.


GOVERNMENT PROGRAMS
Hide details for G1. Has the WVA changed anything for the federally funded Vaccines for Children (VFC)? G1. Has the WVA changed anything for the federally funded Vaccines for Children (VFC)?
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.
Hide details for G2. How does this affect Medicaid and Medicaid managed-care plans? G2. How does this affect 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.
Hide details for G3. How are the vaccines reported for patients who don't have insurance? 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.


PROVIDERS
Hide details for P1. What are the benefits of participating in the program?P1. What are the benefits of participating in the program?
There are many benefits of the state’s universal purchase system.
  • 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.

If you need help billing the Dosage Based Assessment, please contact us at info@wavaccine.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.
Hide details for P2. Do providers need to continue filling out the vaccine reports for Public Health, in addition to completing the DBA? P2. 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.
Hide details for P3. Do providers need to put vaccines for privately insured children in a different refrigerator from federally funded vaccines? P3. Do providers need to put vaccines for privately insured children in a different refrigerator from federally funded vaccines?
No, you don’t need to separate your vaccines. This is one of the benefits of maintaining the universal purchase system.
Hide details for P4. Do providers need to screen for VFC eligibility? P4. Do providers need to screen for VFC eligibility?
Yes. VFC status screening is still a federal requirement for every visit and hasn’t changed. More information about VFC status screening, including frequently asked questions, is available here.
Hide details for P5. Do we still need to report vaccine usage by age group, or will the WVA gather that data? 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.
Hide details for P6. What kind of auditing process can we expect? P6. 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.
Hide details for P7. Will providers receive notification when WVA receives assessments from insurers? P7. Will providers receive notification when WVA receives assessments from insurers?
No, you won’t receive notification, but the DBA shouldn’t show up as accounts receivable in your system. Nor are you responsible for making sure that the WVA receives assessments for the vaccines you administer and document through the DBA process.
Hide details for P8. What actions should Washington providers take when administering vaccines to children who are Idaho residents? P8. 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.
Hide details for P9. Do providers have a choice of vaccine brands?P9. 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.
Hide details for 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? 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?
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.
Hide details for P13. Does the WVA have any requirements for providers regarding a vaccine administration claim?P13. Does the WVA have any requirements for providers regarding a vaccine administration claim?
No, the WVA recommends that providers follow payer guidelines regarding a properly completed medical claims forms. For example, if a payer requests that providers add an "SL modifier" to the vaccine administration, the WVA vaccine assessment requirements that prohibit the addition of any modifier would not interfere with this requirement.


VACCINES
Hide details for V1. What about childhood vaccines that aren’t listed on the WVA Assessment Grid? 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.
Hide details for V2. How are vaccines added to the Assessment Grid?V2. 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


FAQs PDF








WVA Tax ID: 27-2251833 | WVA NPI: 1699092718


Copyright 2013 Washington Vaccine Association