MassHealth has been enrolling and paying eligible local public health departments (LPHDs) and eligible public school districts (PSDs) for purchasing and administering influenza (flu) vaccines to eligible MassHealth members since September 1, 2012. 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, LPHDs and PSDs must be 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. 

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 below for the Billing Instructions section and the MassHealth Flu Vaccine Program Instructions SFY 2014 for Local Public Health Providers pdf file.

What Does MassHealth Cover for Adult Vaccines?

Effective October 1, 2013, eligible LPHDs enrolled in the MDPH Immunization Program and enrolled into the MassHealth Flu and Adult Vaccine 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).

Under the MassHealth Flu and Adult Vaccine Program, LPHDs can elect to provide the above-approved adult vaccines to eligible MassHealth members 19 years of age and older. For more information, please see below for the Billing Instructions section and the MassHealth Adult Vaccine Program Instructions for Local Public Health Departments pdf file.

Program Instructions on COMMBUYS

The following two documents, which more fully articulate the MassHealth Flu and Adult Vaccine Program, are posted on the Commonwealth's new electronic procurement system, COMMBUYS (www.commbuys.com). 

How Cities and Towns Can Enroll

In late August 2013, an e-mail with enrollment packets with the MassHealth Flu Vaccine Program was sent to LPHDs and PSDs already enrolled in the MDPH Immunization Program. To enroll in the MassHealth Flu Vaccine Program, eligible LPHDs and PSDs must complete, sign, and submit all applicable documents in the e-mailed MassHealth Flu Vaccine Program enrollment packet. If your LPHD or PSD is enrolled in the MDPH Immunization Program and did not receive the enrollment packet, please contact MassHealth Customer Service at 1-800-841-2900 (Hours: Monday–Friday, 8:00 a.m.–5:00 p.m.).

Note: effective October 1, 2013, for LPHDs only, MassHealth expanded its vaccine program to cover adult vaccines. In mid-October 2013, MassHealth e-mailed a contract addendum for adult vaccines to LPHDs which were enrolled in the MassHealth Flu Vaccine Program. To receive payments for purchasing and administering the adult vaccines your LPHD must first enroll in the MDPH Immunization Program and then go through the enrollment process for MassHealth Flu and Adult Vaccine Program outlined above.

Enrollment Materials

PSDs must complete and sign:

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 W-9 and the EFT forms.

LPHDs not yet enrolled in the MassHealth Flu and Adult Vaccine Program must complete and sign:

See the checklist for other required forms available at: www.mass.gov/eohhs/gov/departments/masshealth/masshealth-provider-forms.html.

Note: LPHDs must have the municipality’s treasurer sign the W-9 and the Electronic Funds Transfer (EFT) forms.

LPHDs already enrolled in the MassHealth Flu Vaccine Program must sign:

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 MassHealth Customer Service to review the packet’s completeness. MassHealth Customer Service can be reached at 1-800-841-2900 (Hours: Monday–Friday, 8:00 a.m.–5:00 p.m.).

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 unless otherwise instructed by MassHealth in the future.

Billing Instructions

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 age 18. 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 age 19 and older, LPHDs and PSDs can receive payment for purchasing and administration 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 age 19 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.

Note: There are several updates to the 2013-2014 flu and adult procedure codes:

  1. a number of administration procedure codes are now age-based;
  2. when the vaccine is MDPH-supplied, there may be a difference in the payment rates. Please use the “SL” modifier; and
  3. 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:

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 Flu and Adult Vaccine Program’s enrollment, coverage, or claims submission procedures, please contact MassHealth Customer Service at 1-800-841-2900 (Hours: Monday–Friday, 8:00 a.m.–5:00 p.m.) or send an e-mail to providersupport@mahealth.net.

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.