Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines
| To: | Physicians, Advanced Practice Nurses, Local Health Departments, School-Based Linked Health Centers, Local Education Agencies (LEAs), and Medi-Check Clinics |
| Date: | October 14, 2016 |
| Re: | Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines |
This notice provides information regarding the Vaccines for Children (VFC) program. In an effort to ensure Title XXI (21) and State-Funded All Kids eligible children have access to vaccines, the Illinois Department of Public Health (IDPH) is providing Illinois VFC providers the opportunity to order vaccines (317-funded vaccines) through November 26, 2016 or as long as federal funding remains available. Please see IDPH’s notice dated September 30, 2016 for details.
Billing instructions for the transition period are detailed below:
- For vaccines obtained from IDPH through the limited 317 fund supply, providers must charge HFS $6.40 for each vaccine-specific procedure code. Reimbursement will be at the ‘Unit Price” rate found on the Practitioner Fee Schedule.
- For private stock vaccines, providers should charge HFS their usual and customary charge amount for each vaccine-specific procedure code. Reimbursement will be at the lesser of the provider charge amount or the ‘State Max’ rate found on the Practitioner Fee Schedule.
For participants enrolled in one of the Medicaid Managed Care Organizations, providers should contact the individual plan for billing policies and procedures, as well as reimbursement information.
Providers must maintain appropriate documentation in their records to be able to provide in the event of an audit.
Additional information specific to the VFC program changes are located on the Non-Institutional Providers webpage.
Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Felicia F. Norwood
Director
