Frequently Asked Questions About VFC Enrollment
If I have a patient, who does not pay their bills, can I refuse them VFC vaccine?
No. A current patient of yours cannot be refused VFC vaccine for inability to pay the administration fee. However, if you no longer treat the patient because of inability to pay for other services or the office visit fee, follow your current office policy.
Can I give VFC vaccine to my underinsured patients?
No, unless you are a county health department, FQHC, or RHC. If not, you should refer the patient to the nearest FQHC, RHC, or county health department.
What do I do if a patient presents with Medicaid and a third party insurance?
If the patient has Blue Cross Blue Shield insurance or a similar type of prepaid or traditional fee-for-service insurance, give the patient VFC vaccine and file for administration reimbursement with Medicaid using the proper CPT code(s) for the VFC Program (See CPT Codes link on the Alabama VFC Program Web site); Medicaid will file with the insurer. If the patient has insurance through an HMO, you must file with the HMO first and you must use CPT code 90471 (immunization administration). If the claim is denied, you may bill Medicaid for the administration fee using the proper CPT code(s) for the VFC Program. Medicaid always pays for EPSDT visits, including those that include vaccine administration. For more information, please call the Alabama Medicaid Agency at 242-5000.
What is a FQHC or RHC?
A Federally Qualified Health Center (FQHC) is a center that provides health care to a medically under served population and has been conferred by the Health Resources and Services Administration (HRSA). A Rural Health Center (RHC) must be located in a Health Professional Shortage Area, Medically Under Served Area, or a Governor-Designated Shortage Area. RHCs are required to be staffed by PAs, CRNPs, or CNWs at least half the time the clinic is open. For more information, please call Al Fox with the Alabama Primary Health Care Association at 271-7068.
Whose signature goes on the Provider Enrollment?
The intention of the department is to enroll VFC providers who are Alabama-licensed physicians and other health care providers with prescription authority, namely, nurse practitioners and physicians’ assistants.
Does each provider in a practice or hospital have to fill out a Provider Enrollment?
No. Only one Provider Enrollment, Provider Profile, and Vaccine Order Form is needed per clinic site; this will prevent unnecessary duplication of correspondence. However, all providers and their Medicaid numbers should be listed on the back of the Provider Profile; this is necessary to ensure Medicaid reimbursement.
If I don't enroll with the VFC Program can I still see Medicaid patients?
Yes, but Medicaid will not reimburse for the cost of vaccine and administration fee. To receive the administration fee for Medicaid patients, each provider must have a Medicaid number for each site they practice at and each provider must be enrolled in the VFC Program.
Do I have to enroll now?
No. The VFC program has continuous enrollment. But if you need free vaccine or want Medicaid reimbursement, VFC enrollment is necessary.
What if I am a non-Medicaid provider? Can I enroll in the VFC Program?
Yes. A VFC provider does not have to be a Medicaid provider to receive free vaccine. However, it is necessary to become a Medicaid provider in order to receive payment from Medicaid for vaccine administration services provided to Medicaid-eligible patients.
Can I bill the patient an administration fee?
You can bill an administration fee only. This fee must not exceed the administration fee cap established by HCFA. And, you cannot deny vaccines for children if the parent/guardian/patient cannot afford to pay.
What is the regional fee cap for Alabama?
Alabama's administrative fee cap is $19.79 per dose. A VFC provider cannot charge more than the fee cap for each dose of VFC vaccine administered.
If my practice resides in Alabama, but I vaccinate another state's children, where do I receive their vaccine?
You will receive vaccine from the Alabama VFC program because of your practice address. You should bill the patient's Medicaid state for reimbursement. VFC is a national program.
When can I expect shipment of my vaccine order?
You can expect shipment usually within two weeks of receipt of all necessary forms in the VFC office; however, the forms must be completed properly and submitted correctly. We recommend you order a 2-3 month supply of all the vaccine you can use during that period (don't stockpile) and reorder when you are down to a 30-day supply, so that you do not run out.
When can I expect payment from Medicaid?
You can expect to be paid every two weeks for administration fees; however, the claims must be submitted correctly.
Who do I call about Medicaid administration claim information?
Alabama Medicaid Agency's fiscal agent is EDS. They can be reached at 1-800-688-7989.
Do I have to accept new VFC-eligible patients in my practice?
No. You are only asked to vaccinate your current VFC-eligible children and not refer them to the health department. But, if a you want to build your practice, the VFC program can help attract more patients.
Can I request a specific manufacturer's vaccine?
Yes, if the national supplies allows. Currently, DTaP, Hib and Hep B for adolescents and high-risk children can be specified by brand name. According to the OBRA Act of 1993, each manufacturer of the vaccine that meets the terms and conditions will be awarded a contract.