NCAFP, NC Pediatric Society Take Formal Action on Retroactive Immunization Payments

For more than two years, the NC Academy of Family Physicians and the NC Pediatric Society have been advocating for the NC Division of Medical Assistance (DMA) to correct an underpayment of vaccine administrative fees for immunizations provided to Medicaid and NC Health Choice recipients during 2013-2014.

After lengthy discussions with DMA proved unsuccessful, the Academy, the NC Pediatric Society and several large pediatric practices have retained a lawyer and undertaken formal administrative action. The group submitted a Request for Declaratory Ruling in late December that requires NC DMA to issue a formal ruling as to its position on the appropriate payment level. Second, the group also filed a Contested Case Petition with the Office of Administrative Hearings, that directly challenges NC DMA’s refusal to reprocess the vaccine administration claims in question.

The ultimate goal of the action is to have NC DMA to agree to reprocess all affected claims appropriately. It is estimated that family physicians and pediatricians are due about $10 million in unpaid administrative fees. The Academy will keep all members informed on ongoing developments in this matter. Members seeking additional information should contact Greg Griggs at the NCAFP at 919-833-2110 or via email at ggriggs@ncafp.com.