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, Health Care Finance Solutions partnered with the Massachusetts Department of Public Health to increase access to vaccines in public clinics while providing financial support to public providers.
Since the program's inception, it has generated over $11 million in revenue for cities and towns in Massachusetts and Maine.
How Does It Work?
For a 10% fee of paid claims, Health Care Finance Solutions (HCFS) will bill the contracted health plans for the:
- Administration of the influenza vaccine to individuals ages 6 months and older
- Cost of privately purchased influenza vaccine administered to individuals ages 19 and older
- Cost and administration of ACIP recommended adult vaccines
- Cost and administration for influenza and pneumococcal vaccines to Medicare Part B
- Administration of ACIP recommended childhood vaccines
- Cost and administration of vaccines for the MassHealth Flu & Adult Vaccine Program
HCFS will then distribute payments from the private health plans to public providers.
How Can Providers Participate?
In order to participate, public clinic providers must be enrolled in the MDPH Immunization Program and attend an annual training. Trainings are located throughout the state each August and are also available via Webinar throughout the year. The last step to enrolling with the Vaccine Reimbursement program is to complete a simple contract selecting which services your community would like to bill. Please call 800-890-2986 (option 1) to request a contract.
For more information on the MDPH Immunization Program visit: https://www.mass.gov/service-details/vaccine-management
Participating Health Plans
- AllWays Health Partners (f.k.a. Neighborhood Health Plan)
- Anthem **
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Massachusetts Medicare Advantage
- Harvard Pilgrim Health Care
- Harvard Pilgrim Health Care Medicare Advantage
- Health New England
- Health New England Medicare Advantage
- Fallon Medicare Advantage
- Maine Community Health Options **
- Medicare Part B*
- Tufts Health Plan
- Tufts Health Plan Medicare Advantage
- Tufts Health Public Plans
*must be an enrolled provider
**for providers located in Maine
Phone: (800) 890-2986 (Option 1)