Billing Office Tips on Minnesota Vaccines for Children Program (MnVFC)

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Tip #1: Please be prepared to respond to questions about MnVFC eligibility.
Tip #2: Charge only allowable fees for MnVFC.
Tip #3: Be prepared to remove vaccine charges from a MnVFC-eligible patient's bill.
Tip #4: Please waive the administration fee if a patient is unable to pay it.
Tip #5: Make sure you enter the correct CPT code for each vaccine.
Tip #6: Call the MnVFC program if you have complex billing issues.

Your clinic is enrolled in the MnVFC program, through the Minnesota Department of Health. MnVFC pays for vaccine for un- and underinsured children. At the clinic billing office you may get calls from patients who have questions about MnVFC or who request that you adjust their bill for vaccination(s) because they are eligible for MnVFC. Here are some tips for handling those situations.

Tip #1: Please be prepared to respond to questions about MnVFC eligibility.

Your clinic screens patients to find out if they are eligible for MnVFC before giving them immunizations and keeps that screening information on file.

The MnVFC program has a self-screening form for children in several languages that parents can fill out, called Can my child get free or low-cost shots? You might find it a useful reference as well.
Here is a general overview of MnVFC eligibility criteria. For up-to-date details, see the MnVFC Patient Eligibility Screening Record forms.

Children from birth through18 years

Uninsured
Enrolled in a Minnesota Health Care Program:

Medical Assistance (MA),
MinnesotaCare, or a
Prepaid Medical Assistance Program (PMAP)

American Indian or Alaskan Native
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 (MnVFC eligible for non-covered vaccines only)
Has health insurance that caps vaccine coverage at a certain amount; once that amount is reached, the person is MnVFC eligible
Has health insurance with any unmet deductible; once the deductible has been paid, the person is no longer MnVFC eligible
Note: State law requires that Minnesota insurance companies cover immunizations without applying a deductible; this is called first-dollar coverage. Most Minnesotans who have health insurance will not have a deductible for immunizations and therefore will not be considered to be "underinsured" for MnVFC purposes.

Tip #2: Charge only allowable fees for MnVFC.

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. MnVFC covers the cost of vaccines by providing free vaccine to clinics. In addition, the program caps the fee you may charge MnVFC-eligible patients at $14.69 per dose (not per vaccine antigen) for administering MnVFC vaccine. This fee limit is set by federal law. You may also charge for the office visit--but not for the MnVFC vaccine.
To be reimbursed for the administration fee for patients enrolled in a Minnesota Heath Care Program (MHCP), you must follow the billing procedures of each program. MHCP programs include Medical Assistance (MA), MinnesotaCare, or a Prepaid Medical Assistance Program (PMAP). These programs will reimburse you for the contracted administration fee. (See table) For billing questions, call the Minnesota Department of Human Services (DHS) at 651-431-2700.

Permissible MnVFC vaccine administration fees
Patient's status	MnVFC eligible?	Permissible administration fee
Medicaid eligible	Yes	$14.69/dose
Uninsured	Yes	$14.69/dose
American Indian/ Alaska native	Yes	$14.69/dose
Underinsured*	Yes	$14.69 at a federally qualified health center (FQHC) or a rural health center (RHC); usual and customary elsewhere
Privately Insured	No	Usual and customary
* Underinsured: Patients with insurance that either does not cover vaccines, or that covers only selected vaccines (MnVFC eligible for non-covered vaccines only), or that caps vaccine coverage (eligible after cap is reached), or that has any unmet deductible (eligible before deductible has been met).

Tip #3: Be prepared to remove vaccine charges from a MnVFC-eligible patient's bill.

If a patient is potentially underinsured the clinic should tell them it will submit a claim to their insurance company, and if the patient receives a bill for the cost of the vaccine they should contact the clinic billing department. If the patient's insurance denies payment for vaccine, and the patient is eligible for MnVFC, you must remove vaccine charges from their bill. Again, due to our state's first-dollar coverage law, this should be the exception and not the rule.

Tip #4: Waive the administration fee if a patient is unable to pay it.

MnVFC-eligible patients may not be denied vaccine for failure to pay an administration fee. You may bill 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 not acceptable.

Tip #5: Make sure you 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.