UUAV Billing Guidance - Minnesota Dept. of Health

UUAV Billing Guidance

The Minnesota Department of Health (MDH) provides vaccine for uninsured and underinsured adults to providers enrolled in the Uninsured and Underinsured Adult Vaccine (UUAV) program. Your site may get calls from patients who have questions about the UUAV program or who request that you adjust their bill for vaccination(s) because they are eligible. Here is some guidance for handling those situations.

Download PDF version formatted for print: UUAV Billing Guidance (PDF)

#1: Be prepared to respond to questions about UUAV eligibility.

Screen patients at each visit to find out if they are eligible for UUAV before giving them specific immunizations. Keep that screening information on file for three years.

UUAV Eligibility Criteria
Patient must be an adult 19 years or older and:

  • Uninsured, or
  • Has health insurance that does not cover one or more vaccines, as can be the case with newly licensed vaccines that aren’t yet covered (UUAV eligible for non-covered vaccines only), or
  • Has health insurance that caps vaccine coverage at a certain amount; once that amount is reached, the person is UUAV eligible.

For up-to-date details, see the UUAV Patient Eligibility Screening Record forms on the UUAV website.

#2: The UUAV program does not include Minnesota Health Care Program (MHCP) patients.

MHCP patients are considered to be insured and vaccine administered to MHCP patients should be billed to their MHCP plan.

#3: Charge only allowable administration fees for UUAV vaccines.

There are three costs associated with each immunization: the cost of the vaccine, the cost of administering the vaccine, and the cost of the office visit. The UUAV program covers the cost of vaccines by providing free vaccine to enrolled sites. In addition, the program caps the fee you may charge uninsured patients for administering vaccine at $21.22 per dose (not per vaccine component). For patients with insurance, bill your usual and customary administration fee. If the claim is denied, you may only charge the patient $21.22 for the administration fee. You may also charge for the office visit but not for the UUAV vaccine.

#4: Be prepared to remove vaccine charges from a UUAV-eligible patient’s bill.

If a patient is potentially underinsured, the site should tell them it will submit a claim to their insurance company. The patient should contact the site’s billing department if they receive a bill for the cost of the vaccine. If the patient’s insurance denies payment for vaccine, and the patient is eligible for UUAV, you must remove vaccine charges from their bill.

#5: Waive the administration fee if a patient is unable to pay it.

UUAV-eligible patients may not be denied vaccine for failure to pay an administration fee. You may charge a patient for the administration fee, but if they are unable to pay this fee it should be removed from their bill. Having these bills go to collections is unacceptable.

#6: Enter the correct CPT code for each vaccine.

This not only affects the patient’s bill but also their shot record in the statewide immunization registry, which is often derived directly from billing data. The most current CPT codes can be found at MIIC Vaccines and Vaccine Codes.

#7: Refer to the MDH fact sheet, Medicare Coverage of Immunizations.

Immunizations covered by vaccines vary by plan. Medicare Coverage of Immunizations can provide some guidance, but it is best to have the patient contact the customer service number on the back of their insurance card to get more information.

#8: Call the UUAV program if you have complex billing questions.

We will be happy to help. Call 651-201-5522 or 1-800-657-3970.

Updated Monday, 26-Feb-2018 16:13:13 CST