As you know, the State of Illinois has instituted a program change for children with All Kids Insurance, the State’s Child Health Insurance Program (CHIP), also referred to as Title XXI (21) or State Funded coverage. Effective October 1, 2016, children in this program will no longer receive their vaccines through the VFC program. Participants through age 18 with Medicaid coverage (Title XIX (19)) continue to be VFC eligible and will receive their vaccines through VFC.
Harmony-WellCare has evaluated the system modifications that will be necessary to implement these changes and has concluded that it will take between 3 and 4 months to adjudicate claims for vaccine payment. We are also aggressively seeking short term solutions which might allow us to work around this problem and shorten the claims payment timeframe. If such a strategy can be developed, we will let you know as soon as possible.
In the meantime, providers should continue to submit claims to Harmony. They will be paid for the vaccine at the HFS or contracted rate as soon as the system work has been completed. For capitated providers, the vaccine will be paid fee for service (FFS). For FQHCs, the standard encounter rate will be paid, with an add-on for vaccine services.We strongly encourage all providers to comply with the provisions of their contract to accept and provide vaccination services to all Harmony members affected by this program change. In addition, Providers should:
- Purchase private stock vaccine for all CHIP patients;
- Separate private stock from VFC stock vaccine;
- Register for the MEDI system to screen patients for eligibility before every encounter, and
- Capture CHIP eligibility separately from VFC eligibility in the medical record and ICARE.
For more information on how HFS requires vaccination claims/encounter to be submitted per review the documents on the Illinois.gov site at: