We are writing to inform you of an update regarding the reimbursement of vaccines and the related administration for Jefferson Health Plans.

Coding and Reimbursement Change

Effective September 1, 2023, the vaccine administration fee will be reimbursed on the administration code, but only when both the vaccine code and the administration code are on the claim. Claims billed without both the vaccine code and the administration code will result in no payment. Jefferson Health Plans will also pay for the vaccine when appropriate. Please note billed charges greater than or equal to the allowed payment amount must be included on the claim line for the administration code for the payment to process accordingly.

Vaccines for Children program

Jefferson Health Plans requires participating providers who service eligible members in the age ranges of 0 through 18 to obtain their vaccines through the VFC program. Therefore, vaccines through the VFC program are not reimbursable separately. For more information on how to participate in the VFC program:

• In Philadelphia County – Visit the City of Philadelphia, Department of Public Health’s VFC page at vaccines.phila.gov/index.php/vfc.
• Outside of Philadelphia County – Visit the PA Department of Health’s VFC page at health.pa.gov/topics/programs/immunizations/Pages/VFC.aspx.

If you have questions, please call Provider Services at 1-888-991-9023 (Monday to Friday, 9 a.m. – 5:30 p.m.).