Vaccine Payment Challenges Survey

The NAIIS Billing and Coding Work Group is seeking information regarding vaccine billing challenges experienced by providers and their organizations in order to help identify and bring attention to provider vaccine payment issues. This is a pilot project to identify specific examples of payment challenges. The work group will review reports twice a month and reply to those reporting. Where possible, the work group will provide suggestions that may help providers address challenges experienced.

DO NOT REPORT ANY Patient Personal Identifiers (including patient record numbers or contact information).

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* 1. First and Last Name

First name

Last name

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* 2. Name of your organization.

Organization

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* 3. Email of person submitting report for NAIIS to contact if additional billing details are needed.

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* 4. City of the person reporting the issue.

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* 5. State of the person reporting the issue.

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* 6. Name of organization name or practice experiencing billing/payment issue.

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* 7. Organization or practice type

Please specify specialty clinic type or other vaccine provider type

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* 8. Geographic location of practice(s) experiencing billing concerns (check all that apply)

Rural

Urban

Suburban

Single State

Multi-state

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* 9. What benefit were you billing?

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* 10. Is your submission related to vaccine or vaccine administration services payment (check applicable categories):

Claims rejection

Payment delays

Payment inadequacy (paid less than the cost of the vaccine)

Other, please specify

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* 11. Please specify reason(s) given by payer/insurance company for rejection/delay or lower than expected payment:

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* 12. Is payment issue impacting

Only a single payer or plan and small numbers of patients/clients

Only a single payer or plan, but large number of patients/clients

Multiple payers or plans

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* 13. Payer type(s) involved in situation you are reporting: (check all that apply)

Commercial/Private Insurance

Medicare

Medicaid or CHIP

Tricare

Health Insurance Exchange

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* 14. Please describe payment issue in detail. Please do not include Personal Health Information (PHI). Please include name of the Payer, Health Benefit Plan, specific vaccine name, and information about communications with the payer or stated reason for claims rejection, delay or underpayment.

For up to 3 vaccines for which you are noting payment issues, please provide the vaccine name, vaccine brand, vaccine CPT code, and vaccine administration CPT code used. Please be specific.

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* 15. Vaccine 1.

Vaccine Name

Vaccine Brand

Vaccine CPT Code

Vaccine Administration CPT Code

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* 16. Vaccine 2.

Vaccine Name

Vaccine Brand

Vaccine CPT Code

Vaccine Administration CPT Code

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* 17. Vaccine 3.

Vaccine Name

Vaccine Brand

Vaccine CPT Code

Vaccine Administration CPT Code

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* 18. File upload: Explanation of Benefits (EOB) that help explain the payment issue. Please ensure all patient personal information (e.g., name, age, member or account number, date of birth, address) is removed or redacted

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File