June 20, 2024 from Priority Health
Get free vaccines for your eligible patients through the Vaccines for Children Program
What’s the Vaccines for Children (VFC) Program?
The VFC program is a federally funded program offered through the Michigan Department of Health and Human Services (MDHHS) that provides you with vaccines, at no cost, for your Medicaid-eligible patients ages 0 through 18. VFC program providers get free vaccines for eligible patients and are reimbursed for vaccine administration.
Want to know more?
We’ve created a new resource to help you better understand the VFC Program. Our VFC provider toolkit answers questions like:
- What’s the VFC program?
- How does the VFC program support you and your patients?
- What does the enrollment process look like?
You can download the VFC provider toolkit or find it on our Quality Improvement page (login required).
Don’t have time to browse the toolkit? Get our VFC program handout.
TRAINING OPPORUNITIES:
Register now to learn about our 2025 PCP Incentive Program on July 11
Join us for a webinar to learn more about the 2025 PCP Incentive Program (PIP) and the ways your practices can earn incentive dollars for providing high-quality care to our members.
This session will cover:
- A new Access to Care measure, supporting increased efforts to engage your hardest to reach patients
- Care Management monthly PMPM payment, replacing focus measure pre-payments
- Preventive, chronic disease management and Medicare 5-Star measures maintained from 2024
- New disparity measures, addressing differences and/or gaps in health care across racial, ethnic and socio-economic groups
Can’t join us?
All webinars are recorded and posted to our website within a week of the event, so you can watch at your convenience.
REQUIREMENTS AND RESPONSIBILITIES
Reminder: you must refer members to in-network providers, including labs
To help ensure our members get the highest quality, most affordable health care through our network partners, you’re required to use labs that participate in our network. Participating providers have a contractual obligation to use in-network providers when referring our members for services, regardless of your own contracts for referrals with non-participating labs.
Out-of-network labs are not covered for members with HMO plans without an approved authorization, even if the lab is performed on the same day as an office visit with a participating provider.
If an out-of-network lab is necessary for a particular service, a prior-authorization is required. (Learn more about reference lab billing here.)
If an HMO member chooses an out-of-network lab despite the provider’s guidance, the member is responsible for the payment. Under Michigan’s surprise billing legislation, for this to occur, the member must sign documentation from the provider that includes:
- A statement that their insurer may not cover all services
- A "good-faith" estimate for services to be provided
- A statement that the member may request care from an in-network provider and can contact their health plan to discuss
What should providers and facilities do?
Refer your patients to in-network providers and facilities. Use our Find a Doctor tool on priorityhealth.com to find labs that are in-network for your patient’s unique plan. If an out-of-network lab is the only option, follow the steps to request an authorization.
If a Priority Health member chooses to use an out-of-network provider or facility without prior approval, inform the member in writing that they will be responsible for any costs, and ensure you have a documented signature from them affirming their choice.
We’re always here to help
If you can’t find an in-network lab using the Find a Doctor tool, contact the Provider Helpline at 800.942.4765.