Third-party Reimbursement for Vaccines: Effective Billing Strategies for Public Health Departments
Billing private insurance is a relatively new concept for many public health entities. As a result, public health departments have encountered challenges with billing processes for immunization services rendered to privately insured persons. In response to a request from the U.S. Centers for Disease Control and Prevention (CDC), AHIP and its member health plans have worked in collaboration with the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) since 2010 to assist in their efforts to improve public health third-party billing for immunization services.
AHIP and its member plans provide technical assistance to public health departments funded through the Section 317 Immunization Grant Program administered by the CDC. AHIP works with industry experts to provide strategic information and training to public health departments in the areas of Contracting, Credentialing, Coding and Electronic Billing for immunization services. The links below provide access to AHIP presentations developed and presented to public health entities looking to develop or improve their billing for immunization services.
| Presentation | Date | Summary |
| Part Three: Other Issues in Establishing a Vaccine Billing Infrastructure | September 19, 2012 | The 2012 immunization billing webinar series concludes with a final webinar designed to provide public health entities with clarification and updates on billing requirements and frequently asked questions from public health agencies currently working to develop and implement a third-party billing infrastructure for immunization services provided to privately insured individuals. |
| Part Two: Coding and Electronic Billing for Vaccine Delivery | August 22, 2012 | This second webinar session provides public health agencies with effective coding and claim submission strategies for vaccines and immunization services. Industry experts provide public health entities with best practices for proper coding and resources for efficient claim submission. The webinar also outlines the electronic claims submission process and capabilities of a large member health plan. |
| Part One: Strategies for Contracting Health Plans for Vaccine Delivery | July 18, 2012 | The first of three webinar training sessions on public health third-party billing for vaccines, this presentation provides public health entities with detailed, strategic steps for contracting with health plans for immunization services and outlines the processes of contracting with two large member health plans for immunization services. |
| Credentialing with Health Plans: An Overview | February 21, 2012 | This presentation provides public health entities with specific credentialing requirements, a health plan credentialing workflow and credentialing protocols. |
| Understanding Health Plan Reimbursement Policies for Immunization Services | July 28, 2011 | In July 2011, AHIP and our member plans partnered with the CDC and the Association of State and Territorial Health Officials (ASTHO) to co-host the first stakeholder meeting for state and local health departments in Washington DC. This presentation highlights key components of an effective third-party billing mechanism for immunization services. |
| Insurance 101 | April 13, 2010 | AHIP introduces health plan reimbursement policies and third-party billing processes for immunization services to public health entities in this presentation to state and local health departments. |
Handouts
AHIP and its member health plans provide tools and resources to public health entities to help them navigate through the world of third-party billing and reimbursement for immunization services.
- 2012 Aetna Claim and Account Management Tool - Webinar Sessions, August 22, 2012
- 2012 Doing Business with Aetna - Webinar Sessions, August 22, 2012
- AHIP’s Health Plan Immunization Contract Representatives, July 18, 2012
- Requirements for Credentialing of Medical Doctors by State, February 21, 2012
- State Credentialing Application Forms, February 21, 2012
- Simplifying Provider Data Collection – Universal Provider Data Source, A CAQH Initiative, February 1, 2012
- A Health Plan Credentialing Workflow, February 21, 2012
- Immunizing Insured Individuals in a Public Health Setting: A Fact Sheet on Health Plan Reimbursement, January 2012