Immunizations: Adolescents Tip Sheet

Incentives are paid to the linked primary care provider (PCP) on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

• Administrative members on date of 13^th  birthday.
• Dual coverage members.
• Members in hospice, receiving hospice services or who died during the measurement year.

Providers must document each member’s need for recommended immunizations as part of all regular health visits, including, but not limited to, the following types of encounters:

• Illness, care management or follow-up appointments
• Initial Health Appointments (IHAs)
• Pre-travel visits
• Sports and school physicals
• Visits to local health departments
• Well-patient checkups

All California healthcare providers who administer vaccines must also enter immunization information for each patient into the local immunization registry within 14 calendar days, in accordance with state and federal laws.

Members meet measure requirements when they receive all of the following:

• Meningococcal (serogroups A, C, W and Y or A, C, W, Y and B)
  • At least one dose administered on or between the member’s 10th and 13th birthdays; or
  • Anaphylaxis due to the vaccine any time on or before the member’s 13th birthday.
  • Acceptable codes: 90619, 90733, 90734, 90623 (Menactra, Menveo, MenACWY, Menomune, PENBRAYA); 428301000124106 (anaphylaxis due to the vaccine).
• Tdap
  • At least one dose administered on or between the member’s 10th and 13th birthdays; or
  • Anaphylaxis or encephalitis due to the vaccine any time on or before the member’s 13th birthday.
  • Acceptable codes: 90715 (Adacel, Boostrix); 428281000124107, 428291000124105 (anaphylaxis due to the vaccine); 192710009, 192711008, 192712001 (encephalitis due to the vaccine).
• HPV:
  • Two doses administered at least 146 days apart on or between the member’s 9th and 13th birthdays; or
  • At least three doses administered on or between the member’s 9^th and 13^th birthdays; or
  • Anaphylaxis due to the vaccine any time on or before the members 13th birthday.
  • Acceptable codes: 90649, 90650, 90651; 428241000124101 (anaphylaxis due to HPV vaccine).

Note: SNOMED codes indicating anaphylaxis or encephalitis from vaccines need to be submitted via the Alliance Data Submission Tool (DST).

Data for this measure is collected using claims, immunization registries (CAIR & RIDE), DHCS fee-for-service encounter claims 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. For example, download your monthly Adolescent Immunizations Quality report from the Provider Portal and compare it to your EHR/paper records.

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.

• Build the member’s trust and confidence by addressing concerns and misconceptions proactively and confidently.
  • For example: The HPV vaccine is all about cancer prevention. Starting the series at age 9 gives the immune system its best chance to build long-lasting cancer prevention before there’s any risk of exposure.
• Check if the member’s CAIR or RIDE (immunization registry account) is locked. This prevents visibility of the chart and data sharing. Parents can submit a CAIR form to unlock the child’s record. If able, help the parents complete the electronic form while they’re in the office.
• Review charts prior to members’ visits, incorporate and review standing orders to ensure vaccines are available during all visits and train staff accordingly.
• Adjust reminder and recall systems to meet community needs (back-to-school, flu season, emergent disease).
• Provide extended clinic hours, weekend appointments or walk-in vaccination services.
• Provide clear, age-appropriate educational materials about the importance, safety and benefits of vaccines.
• Use the Alliance Provider Portal reports and immunization registry (CAIR or RIDE) to identify patients due for a vaccine.
• Keep staff up to date on current recommendations and the safety of vaccines by using resources such as HealthyChildren.org.
• Share performance data with providers and staff to identify areas that need improvement, then reward individuals or teams who achieve higher rates.
• Ensure staff has current accounts with the local immunization registry and is trained to enter both administered vaccines and vaccines from health records into the registry.
• Route after-hours calls from the Alliance members to the Nurse Advice Line: 844-971-8907.

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – Request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Service – Directly access a telephonic interpreter 24 hours a day, 7 days a week.
  • Interpreter Services – Can be requested for the appointment with the member.
  • Virtual Remote Interpreter (VRI) Service – When an in-person interpreter might not be available or easy to access.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Transportation Services for patients with transportation challenges.
  • For non-emergency medical transportation (NEMT) services, call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • For non-medical transportation (NMT) services, call 800-700-3874, ext. 5577 (TTY: Dial 711).
• California Immunization Registry (CAIR) - Callifornia Department of Public Health.
• Healthy Futures Public Health information system.
• Start at 9 Toolkit - National HPV Vaccination Roundtable.
• Strategies for Improving Vaccine Communication and Uptake – American Academy of Pediatrics.
• Tips for Speaking with Parents about Flu Vaccine | How to Address Common Concerns – California Vaccines for Children (VFC).