Immunizations: Adolescents Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.

Members in hospice or using hospice services anytime during the measurement year.

Members who died any time during the measurement year (CBI 2024 only).

Members meet the measure requirements when they have received all of the following:

Meningococcal Vaccine

• At least one vaccine administered with a date of service on or between the member’s 11th and 13th birthdays or anaphylaxis due to the meningococcal vaccine any time before the member’s 13th birthday.
• Acceptable codes: 90619, 90733, 90734 (Menactra, Menveo, MenACWY, Menomune); 428301000124106 (Anaphylaxis due to MCV vaccine).

Tdap Vaccine

• At least one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine administered with a date of service on or between the member’s 10th and 13th birthdays or anaphylaxis or encephalitis due to tetanus, diphtheria or pertussis vaccine any time before the member’s 13th birthday.
• Acceptable codes: 90715 (Adacel, Boostrix); 428281000124107, 428291000124105 (Anaphylaxis due to Diphtheria, Tetanus or Pertussis Vaccine); 192710009, 192711008, 192712001 (Encephalitis due to Diphtheria, Tetanus or Pertussis Vaccine).

HPV Vaccine: Any of the following meet criteria

• At least two HPV vaccine with dates of service at least 146 days apart on or between the member’s 9th and 13th birthdays
• At least three HPV vaccines with different service dates on or between the member’s 9^th and 13^th
• Anaphylaxis due to the HPV vaccine any time on or before the members 13^th
• Acceptable codes: 90649, 90650, 90651; 428241000124101 (Anaphylaxis due to HPV vaccine)
  Note: HPV vaccination routinely recommended at age 9–12 years.

Data for this measure will be collected using claims, immunization registries (CAIR & RIDE), DHCS Fee-for-Service encounter claims, Santa Cruz Health Information Exchange (SCHIE) and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your electronic health record (EHR) system; or.
• Manually compile patient data (Example: Download monthly adolescent immunizations quality report or your Care-Based Incentives Measure Details report on the Provider Portal and compare to EHR/paper charts).

This measure allows providers to submit immunization codes from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

• Review standing orders to ensure that vaccinations are available during all visits, including sick or well-visits, regular hours or weekend clinics.
• Ensure staff has current accounts with your local immunization registry, and staff are trained to enter both administered vaccines and vaccines from health records into the registry.
• Check the registry prior to administering any vaccines to ensure the member has not already received the vaccine.
• Keep clinical staff up to date with current recommendations and communication tools, such as the CDC’s Provider Resources for Vaccine Conversations with Parents.
• Know your vaccination rates. Utilize the Alliance’s Provider Portal reports to monitor your clinic’s vaccine rates.
• Voice your strong support of immunization. Confident recommendation and education by a health care professional is the main reason parents decide to vaccinate.
• Recommend the HPV vaccine the same day and the same way you recommend all other vaccines. For example, “Now that Miguel is 11, he is due for vaccinations to help protect against meningitis, HPV cancers and whooping cough. We’ll give those shots during today’s visit. Do you have any questions about these vaccines?”
• Motivate your team and encourage their immunization conversations with parents and to begin preparing teen parents/guardians for the vaccinations early.
• Empower staff to chart prep to review the schedule of immunizations and avoid any missed opportunities like providing a vaccine during a sick visit.
• Maintain strong doctor-patient relationships to help with challenging immunization conversations.
• Learn how to answer some of parents’ most common questions about the HPV vaccine and other vaccines. Review this HPV fact sheet published by the American Cancer Society:
  • HPV Provider Fact Sheet
• Use personal examples of how you choose to vaccinate children in your family.
• Utilize an immunization checklist to improve your clinic’s vaccine compliance, such as the Immunization Action Coalition (IAC’s) Suggestions to Improve Immunization Services.
• Route after-hours calls from Alliance members to the Alliance’s Nurse Advice Line: 844-971-8907.

• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients that have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874 ext. 5577. This service is not covered for non-medical locations or appointments that are not medically necessary.
• The Alliance’s Immunization Resources web page
• CDC Top 10 Tips for HPV Vaccination Success: Attain and Maintain High HPV Vaccination Rates
• CAIR Immunization Registry http://cairweb.org/ for Santa Cruz and Monterey Counties.
• RIDE (Healthy Futures) Immunization Registry http://www.myhealthyfutures.org/ for Merced County.
• California Immunization Coalition.
• National HPV Vaccination Roundtable: Start at 9 Toolkit.
• Vaccines for Children (VFC) Program