Checks Finally Coming Through for Vaccine Underpayments

The $10-$12 million in underpayments for vaccine administration in 2013 and 2014 are beginning to arrive in mailboxes of pediatric practices. The underpayment affected approximately 2.5 million vaccinations administered to Medicaid patients under the Vaccines for Children (VFC) program during those years.

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.

The NC Department of Health and Human Services (NCDHHS) identified all codes that were underpaid and will remit the difference directly to each affected practice. 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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