ForwardHealth Expands Vaccine Billing Process Changes

By February 1, 2026: Billing team must implement the following changes: (1) Update billing system to require BOTH vaccine product code AND vaccine administration code on all vaccine claims; (2) Configure system to append SL modifier to vaccine product codes ONLY for VFC-supplied vaccines (not administration codes); (3) For pharmacy providers not enrolled in VFC: Program system to bill only administration fees for members aged 18 and younger (except COVID-19 and influenza vaccines which can include product cost through 12/31/2029); (4) For pharmacy providers not enrolled in VFC: Program system to bill both product and administration for members aged 19 and older; (5) Update claims submission workflows to validate modifier placement and code combinations before submission. Train billing staff on new requirements. For any claims submitted without proper code pairing or modifiers, resubmit corrected claims to ensure proper reimbursement. Failure to include required codes and modifiers will result in claim denials or underpayment.