Vaccine Underpayments Will Be Paid by July 1, 2018

The $10-$12 million in underpayments for vaccine administration in 2013 and 2014 will be paid by the end of June, the North Carolina Department of Health and Human Services Deputy Secretary for Medical Assistance Dave Richard told the General Assembly’s Joint Legislative Committee for Health and Human Services last week. The underpayment affected approximately 2.5 million vaccinations administered to Medicaid patients under the Vaccines for Children (VFC) program.

Last year, the North Carolina Pediatric Society and the North Carolina Academy of Family Physicians (NCAFP) along with eight member practices were victorious in their lawsuit to correct underpayment of the vaccination administration fees. In November, the NC Division of Medical Assistance (DMA/Medicaid) decided not to appeal the Superior Court’s decision that they must rectify the underpayment of Medicaid vaccine administration payments made in 2013 and 2014. Superior Court Judge Beecher R. Gray allowed DMA until November 2018 to reprocess the claims.

Richard told committee members NCTracks programming to re-process the underpayments is underway and will be made by the end of the state fiscal year, June 30. DHHS is identifying all codes that were underpaid and will remit the difference directly to each affected practice, so no action is needed by practices and physicians who may be owed payments. Practices will be reimbursed $6.74 per qualifying vaccine.

The North Carolina Medical Society (NCMS) once again congratulates the NC Pediatric Society and the NCAFP for this important legal victory on an issue that the NCMS and the other organizations have long advocated to correct.


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1 Comment

  • Graham Barden

    I am pleased the State is doing this earlier than the deadline! By the Private Practices and NC Peds/Family Practice associations winning this court battle, CMS is on the hook for all of the monies – none from NC. CMS was initially “on the hook” but the court order now guarantees it even though the ACA ended in 2014. None of us should be afraid to challenge payers when they are wrong! We were not reimbursed for legal fees, but our members are donating a portion of the receipts to fund this suit and possible future “disagreements.”