Date: January 17, 2017
To: All Medical Assistance Providers
Re: Vaccines for Children (VFC) program - Private Stock Vaccines
Re: Vaccines for Children (VFC) program - Private Stock Vaccines
This notice provides additional information regarding the recent Vaccines for Children (VFC) program changes. Effective with dates of service October 1, 2016, through the end of the State fiscal year, June 30, 2017, the Department will reimburse providers an additional $6.40 for fee-for-service private stock vaccines when administered to Title XXI (21) and State-Funded eligible children.
When billing private stock vaccines administered to Title XXI (21) and State-Funded eligible children, providers must add $6.40 to their usual and customary charge amount for each vaccine-specific procedure code. HFS will reimburse fee-for-service claims at the lesser of the provider charge amount or the sum of the rates shown in the State Max and Unit Price columns of the Practitioner Fee Schedule.
The Department will initiate and process adjustments for claims that have been adjudicated for dates of service beginning October 1, 2016. Once claims have been adjusted, the HFS 194-M, paper remittance advice will identify them with Adjustment Reason Code 3451 – Vaccine Adj/Non-Title 19. Providers should not initiate adjustments on any claims already billed to the Department.
Billing procedures for Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) and Encounter Rate Clinics (ERCs) will remain the same as communicated in the September 19, 2016 Provider Notice.
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.
Additional information specific to the VFC program can be found on the Non-Institutional Providers webpage. For additional questions, please contact the Department’s Bureau of Professional and Ancillary Services at
877-782-5565.
Felicia F. Norwood
Director
