Vaccine Reimbursement Program for Public Providers

History

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 $7 million in revenue for cities and towns in Massachusetts.

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 providers must attend a training (located throughout the state in late summer and available in a webinar), and submit a simple contract to HCFS. Please call 800-890-2986 (option 1) to request a contract.

Participating Health Plans

  • AllWays Health Partners (f.k.a. Neighborhood Health Plan)
  • Blue Cross Blue Shield of Massachusetts 
  • Blue Cross Blue Shield of Massachusetts Medicare Advantage
  • Cigna
  • Harvard Pilgrim Health Care
  • Health New England
  • Health New England Medicare Advantage
  • Fallon
  • Fallon Medicare Advantage  
  • Medicare Part B*
  • Tufts Health Plan
  • Tufts Health Public Plans
  • Tufts Health Medicare Advantage
  • Unicare
  • MassHealth*  

*must be an enrolled provider

Contact Us

Email: vaccine@umassmed.edu
Phone: (800) 890-2986 (Option 1)

 

Keep your family strong. Vaccinate. Fight Flu.