Lessons Learned: Billing Insurance at Local Public Health Units In North Dakota

Background:  North Dakota used to supply vaccine for all children, including those with insurance. In 2008, the state started supplying vaccines only to children eligible for the Vaccines For Children Program, which meant providers, including local public health units, had to start purchasing private vaccines and billing insurance.

Setting:  There are 28 autonomous local public health units in North Dakota, which have offices in each of the 53 counties. Twenty-five of the 28 health units purchase private vaccines and bill insurance for immunizations administered to children with private health insurance.

Population:  In 2009, the health units administered 43,159 doses to insured children 18 and younger. They billed vaccines to 116 different insurance companies. Seventy-eight percent of insured children seen at health units in North Dakota have BCBSND insurance.

Project Description:  The health units use the North Dakota Immunization Information System (NDIIS) to bill insurance for doses administered. Insurance data for BCBS patients is sent directly to the company from NDIIS and the health units are reimbursed on a weekly basis. Data for non-BCBS clients is sent to a third party billing agency who bills other insurance companies and the patients for any member-liable amounts.

Results/Lessons Learned:  Advantages to billing insurance at health units include serving the immunization needs of insured children. Fifty-six percent of doses administered to children went to those with health insurance. Also, federal 317 vaccine was previously used to provide vaccines to insured children and is now freed up for special projects, such as human papillomavirus vaccine for uninsured adults. Disadvantages include that almost 12% of commercial, non-BCBS claims were denied due to the health units being “out-of-network” providers. Also, there are high costs ($2 per dose) associated with using a third party biller. Billing stakeholders, including health units and the Department of Health, continue to have monthly meetings to resolve billing issues.