Vaccine Reimbursement

Vaccines are a critical part of public health, helping prevent a wide range of diseases and infections. Many public and municipal health departments are responsible for providing access to certain vaccinations – including the influenza vaccine – in public settings for many at-risk populations, such as children and elders. Yet many of these public clinics have no reimbursement mechanism for administering the vaccines, which often creates financial challenges.

We have a vaccine reimbursement program that can help. Our program aims to alleviate the financial strain on public health departments by providing a billing service for the cost and administration of flu and adult vaccines. This creates a funding source for the municipality.

After the clinic, we bill the contracted health plans for the administration and/or cost of the influenza vaccine on behalf of the public providers that enroll with us. The health plans then provide payments back to us, and we in turn distribute the funds to the providers. We also do this with other Advisory Committee on Immunization Practices-recommended adult vaccines, such as the pneumococcal vaccine, for Medicare Part B, Medicaid, and commercial health plan members.

This program has generated more than $5 million in revenue for cities and towns in Massachusetts and Maine since its inception. Our services include:

  • Contracting with health plans
  • Eligibility determination
  • Electronic submission of claims to Medicare, Medicaid and commercial health plans.
  • Follow up and resubmission of any claims that need re-adjudication 
  • Guidance for enrolling or revalidating with Medicare
  • Customer support and training
  • Payment distribution