Immunizations: Children (Combo 10) 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 child’s second birthday.
• Dual coverage members.
• Members in hospice, receiving hospice services, or who died during the measurement year.
• Members who had a contraindication to a childhood vaccine on or before their second birthday. Examples include severe combined immunodeficiency, immunodeficiency, HIV, multiple myeloma, leukemia, or intussusception. See complete list of exclusion codes in the CBI Technical Specifications.

Note: Laboratory claims with POS 81 are not included to identify eligible members with contraindications to childhood vaccines.

Providers must document each member’s need for Advisory Committee on Immunization Practices (ACIP) 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.

To view applicable codes for the measure, see the CBI Technical Specifications.

Note: All codes indicating anaphylaxis or encephalitis from vaccines are SNOMED codes that cannot be sent through a claim and must be received electronically. Claims with POS 81 will not be used in capture history of illness for hepatitis B, varicella zoster (chicken pox), hepatitis A, measles, mumps, or rubella.

Data for this measure is collected using claims, immunization registries (CAIR or 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 Childhood Immunizations Quality report or Care-Based Incentives Measure Details report on the Provider Portal and compare it to your 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, 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 by demonstrating empathy, providing evidence-based information, addressing misinformation, and empowering their choice to vaccinate.
  • Studies show that getting multiple vaccines during the same visit is safe and does not increase your risk of adverse effects. In fact, following the recommended schedule ensures that you are protected against dangerous diseases like measles, whooping cough and polio.
• Review charts prior to members’ visits, incorporate and review standing orders to ensure vaccines are available during all visits and train staff accordingly.
• 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.
• Discuss and offer vaccines at each visit. Most vaccines can be administered even if the child has a mild illness.
• Ensure staff has current accounts with your local immunization registry and is trained to enter both administered vaccines and vaccines from health records into the registry. Providers are required to enter vaccine information into the immunization registry within 14 days of vaccine administration.
• Keep staff up to date on current recommendations and communication tools, such as Vaccines for Your Children – CDC.
• Always screen for contraindications. Most vaccines can be administered even if the child has a mild illness.
• Identify members due for a vaccine using the Provider Portal reports and immunization registry (CAIR or RIDE).
• Provide members with a copy of the CDC recommended immunizations schedule:
  • Recommended Immunizations for Birth Through 6 Years Old - English
  • Recommended Immunizations for Birth Through 6 Years Old - Spanish
• Route after-hours calls from 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 Services – available to assist in scheduling members.
  • Face-to-Face Interpreter Services – can be requested for the appointment with the member.
  • 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.
  • Non-emergency medical transportation (NEMT), call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • Non-medical transportation (NMT), call 800-700-3874, ext. 5577 (TTY: Dial 711).
• About the Vaccines for Children (VFC) Program – CDC.
• California Immunization Coalition.
• California Immunization Registry (CAIR).
• Healthy Futures Public Health information system.
• Strategies for Improving Vaccine Communication and Uptake – American Academy of Pediatrics.