MassHealth is enrolling and paying eligible local public health departments (LPHDs) and eligible public school districts (PSDs) for purchasing and administering influenza (flu) and certain adult vaccines to eligible MassHealth members. The goal of this initiative is to provide MassHealth members with increased access to flu and adult vaccines in public health settings and in geographic areas where MassHealth members have difficulty accessing vaccines.
Before enrolling in the MassHealth Flu and Adult Vaccine Program (the MassHealth Program), LPHDs and PSDs must be enrolled (and annually re-enrolled) in the Massachusetts Department of Public Health (MDPH) Immunization Program. If LPHDs or PSDs are not yet enrolled in MDPH’s Immunization Program, please call 617-983-6828 to enroll.
To confirm eligibility for applying to the MassHealth Program, please call MassHealth at 617-847-3130.
What Does MassHealth Cover for Flu Vaccines?
MassHealth pays for administration of flu vaccines when LPHDs and PSDs provide MDPH-supplied flu vaccines to eligible MassHealth members up to and including 18 years of age. In addition, MassHealth pays LPHDs for purchasing and administering flu vaccines for eligible MassHealth members 19 years of age and older. For more information, please see the “MassHealth Flu and Adult Vaccine Program Instructions - 2014-2015” and the Billing Instructions section below.
What Does MassHealth Cover for Adult Vaccines?
Eligible LPHDs enrolled in both the MDPH Immunization Program and the MassHealth Program can receive payment for purchasing and administering adult vaccines to eligible MassHealth members 19 years of age and older. MassHealth will cover the following adult vaccines recommended by the U.S. Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP): hepatitis A; hepatitis B; hepatitis A and hepatitis B (HepA-HepB); human papilloma virus (HPV); measles, mumps, and rubella (MMR); meningococcal conjugate; meningococcal polysaccharide; pneumococcal conjugate; pneumococcal polysaccharide; tetanus toxoid adsorbed; tetanus and diphtheria toxoids, and acellular pertussis (Tdap); varicella; and zoster (shingles).
MassHealth encourages LPHDs to provide the above-approved adult vaccines to eligible MassHealth members 19 years of age and older. For more information, please see the “MassHealth Flu and Adult Vaccine Program Instructions - 2014-2015” and the Billing Instructions section below.
Program Instructions on COMMBUYS
The following document, which more fully articulates the MassHealth Flu and Adult Vaccine Program, is posted on the Commonwealth's new electronic procurement system, COMMBUYS (www.commbuys.com/bso): "MassHealth Flu and Adult Vaccine Program Instructions - 2014-2015 ."
How Cities and Towns Can Enroll
On an annual basis, MassHealth e-mails enrollment and informational packets to LPHDs and PSDs that participate in the MDPH Immunization Program. However, providers are responsible for monitoring the Commonwealth of Massachusetts’ eProcurement/Purchasing System (COMMBUYS) and obtaining the most updated documentation and notices posted on the COMMBUYS website.
To enroll in the MassHealth Program, eligible LPHDs and PSDs must complete, sign, and submit all applicable documents in the e-mailed MassHealth Program enrollment packet. If your LPHD or PSD is enrolled in the MDPH Immunization Program and did not receive an enrollment packet, please contact MassHealth at 617 -847-3130 .
Note: LPHDs already enrolled in the flu component of the Program should contact 617-847-3130 to obtain a copy of the Amended and Restated MassHealth Flu and Adult Vaccine Program Provider Contract. To receive payments for purchasing and administering the adult vaccines your LPHD must first be actively enrolled in the MDPH Immunization Program and then go through the enrollment process for the MassHealth Program outlined above.
- For LPHDs and PSDs: “MassHealth Flu and Adult Vaccine Program Provider Application.” Contact 617-847-3130 to obtain this document.
- For PSDs: “MassHealth Flu Vaccine Provider Contract” . Contact 617-847-3130 to obtain this document.
- For LPHDs: “MassHealth Flu and Adult Vaccine Program Provider Contract” or “Amended and Restated MassHealth Flu and Adult Vaccine Program Provider” (for LPHDs already enrolled in the Flu component of the Program). Contact 617-847-3130 to obtain these documents.
- MassHealth Flu and Adult Vaccine Program Provider Checklist
See the checklist for the list of other required forms which are available at www.mass.gov/eohhs/gov/departments/masshealth/masshealth-provider-forms.html.
Note: PSDs must have the school district’s appropriate administrator sign the Massachusetts Substitute W-9 and the Electronic Funds Transfer (EFT-1) forms.
Note: LPHDs must have the municipality’s treasurer sign the Massachusetts Substitute W-9 and the (EFT-1) forms.
To confirm eligibility, MassHealth recommends that a representative of the LPHD or PSD call MassHealth at 617-847-3130.To expedite enrollment, once an LPHD or a PSD has completed its enrollment packet, and prior to submission, MassHealth recommends that a representative of the LPHD or PSD call the MassHealth Customer Service Center at 1-800-841-2900 (Hours: Monday–Friday, 8:00 a.m.– 5:00 p.m.) to review the packet’s completeness.
Completed and signed enrollment packets should be sent to the following address.
MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton, MA 02021
Note: MassHealth will not pay for services provided before the date of the approved and signed contract.
Note: Once an LPHD or a PSD is enrolled in the respective component of the MassHealth Flu and Adult Vaccine Program, it does not need to renew its Provider Contract with MassHealth unless otherwise instructed by MassHealth in the future. However, in order to maintain eligibility, the LPHD and/or PSD must re-enroll on an annual basis in the MDPH Immunization Program.
MassHealth Flu Vaccine Component
LPHDs and PSDs enrolled in the MDPH Immunization Program receive state-supplied flu vaccine from MDPH at no cost for children up to and including 18 years of age. If an LPHD or a PSD is using state-supplied vaccine, it should not submit a claim for the vaccine’s cost to MassHealth or to a MassHealth managed care organization (MCO) as the claim will be denied. For patients 19 years of age and older, LPHDs and PSDs can receive payment for purchasing and administration of flu vaccines at fee-for-service rates. MassHealth will not pay for a MassHealth member enrolled in an MCO – such claims must be submitted to the respective MCOs.
MassHealth Adult Vaccine Component
When LPHDs purchase adult vaccines for patients 19 years of age and older, MassHealth will pay the LPHDs for purchasing and administering the vaccines at fee-for-service rates. MassHealth will not pay for a MassHealth member enrolled in an MCO – such claims must be submitted to the respective MCOs.
- A number of administration procedure codes are now age-based.
- When the vaccine is MDPH-supplied, there may be a difference in the payment rates. Please use the “SL” modifier.
- Flu vaccine code 90686 (age 19+) will be reimbursed based on “individual consideration” (I.C.), i.e., payment will be based on the manufacturer’s invoice indicating the exact number of doses and price per dose (MassHealth only will cover the cost for properly submitted invoices).
When submitting a claim for vaccine services, LPHDs and PSDs should record the member’s MassHealth ID and type of coverage in addition to his/her name, date of birth, vaccine name, and date of service.
LPHDs and PSDs can submit claims to MassHealth using:
- Direct Data Entry (DDE): https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/appmanager/provider/desktop
- Approved MassHealth vendor: the list of approved vendors can be found at: www.mass.gov/eohhs/docs/masshealth/privacy/hipaa-vendor-list-production.pdf
Note: Providers must submit claims to MassHealth within 90 days of the service date. Providers that choose to use a billing vendor should ensure that the vendor submits the provider’s claims on a timely basis.
Questions about the MassHealth Flu and Adult Vaccine Program?
If you have any questions about the MassHealth Program’s enrollment documents, please contact (617) 847-3130. If you have any questions about the MassHealth Program’s coverage or claims submission procedures, please contact the MassHealth Customer Service Center at 1-800-841-2900 (Hours: Monday–Friday, 8:00 a.m.– 5:00 p.m.) or send an e-mail to firstname.lastname@example.org.
Questions about the MDPH Vaccine Programs?
If you have clinical questions about vaccines or vaccine-preventable diseases, please call the MDPH Epidemiology and Immunization Unit at 617-983-6800.