Vaccine Reimbursement Program for Public Providers

The unexpected H1N1 influenza pandemic placed an added financial burden on cities and towns in Massachusetts that were already facing major fiscal challenges. Local boards of health were responsible for conducting H1N1 and seasonal influenza vaccination clinics for large numbers of children and families without a mechanism for reimbursement. Historically, health plans did not cover the cost of administering the influenza vaccine outside of the primary care setting. To relieve the financial strain on the boards of health, the Center for Health Care Financing partnered with the Massachusetts Department of Public Health and the Massachusetts Association of Health Plans to create a streamlined process for locally sponsored public flu clinics across the Commonwealth to obtain reimbursement from major health plans.

This program helps public providers to serve individuals of all ages in their community and removes potential barriers to vaccinations.

CHCF is pleased to announce that the health plans will cover all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This initiative will allow public providers to increase vaccine coverage rates and decrease vaccine-preventable diseases among members of their community.

 

How Does It Work? 

For a 10% fee, the Center for Health Care Financing (CHCF) will bill the contracted health plans for the: 

  • Administration of the influenza vaccine to individuals ages 6 months and older 
  • Cost of privately purchased vaccine administered to individuals ages 19 and older 
  • Administration of the pneumococcal vaccine to Medicare Advantage members  
  • Cost and administration of ACIP recommended adult vaccines

CHCF will then distribute payments from the private health plans to public providers.

 

Medicare Part B Billing

CHCF now offers Medicare Part B billing services for the Influenza and Pneumococcal Vaccines. Please contact us directly through the information listed below if you are interested in contracting with us to bill your Medicare Part B claims.

 

How Can Providers Participate?

In order to participate public providers must attend a training (located throughout the state in late summer or attend a Webinar training), and submit two signed originals of the contract to CHCF, located to the left under Documents and Forms. For cities and towns to receive payment, they must also submit a University of Massachusetts Substitute W-9 Form (Form UMW-9) to Commonwealth Medicine. Please feel free to contact us with any questions regarding the contracting process.

 

2014-2015 Contracted Health Plans

  • Aetna
  • Blue Cross Blue Shield of Massachusetts 
  • BMC HealthNet  
  • Celticare
  • Cigna
  • Fallon 
  • Harvard Pilgrim 
  • Health New England  
  • MassHealth*
  • Neighborhood Health Plan 
  • Network Health
  • Tufts 
  • Unicare  

*If you are eligible and choose to complete MassHealth's application process.

 

Contact Us:

Holly Oldham

Brittany Tibbetts

Andrew Wagner

Email: vaccine.reimbursement@umassmed.edu
Phone: (800) 890-2986