COVID-19 Medi-Cal Response

The Department of Health Care Services (DHCS) continues to closely monitor and respond to COVID-19, and is providing information on this web page to all providers as a reminder of recommended safety procedures and protocols from the federal Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) to help prevent spread of COVID-19. Providers are encouraged to check this page for regular updates to the Medi-Cal response to COVID-19, as well as the Medi-Cal homepage.


Frequently Asked Questions (FAQs)

Vaccine Administration

Current Direction on Claims Submission

To assist providers with claims submission for the administration of the COVID-19 vaccine, Medi-Cal has provided a summary of the most current direction that providers are being asked to follow. This table is updated as changes are made.

Pharmacy Claim Submissions

Submission Type Can I submit claims? Anything else I should know?
NCPDP D.0 Transactions Providers may submit claims as of December 29, 2020 No
Real Time Internet Pharmacy (RTIP) Providers may submit claims as of January 3, 2021 No
NCPDP 1.2 (Batch) Please continue to hold claim submission No
Pharmacy Claim Form (30-1) Please continue to hold claim submission No

Medical and Outpatient Submissions

Submission Type Can I submit claims? Anything else I should know?
ASC X12N 837 v.5010 Providers may submit claims as of December 29, 2020 Claims will be put in “pending” status initially
Internet Professional Claim Submission (IPCS) Providers may submit claims as of December 29, 2020 Claims will be put in “pending” status initially
CMS-1500 Providers may submit claims as of December 29, 2020 Claims will be put in “pending” status initially
UB-04 Providers may submit claims as of December 29, 2020 Claims will be put in “pending” status initially

Once providers are cleared to begin claim submission, they should keep in mind that possible pauses in payment should not be cause for providers to:

  • Decline administering initial or second dose of the COVID-19 vaccine.
  • Delay submitting claims for administration of initial or second dose of the COVID-19 vaccine.

For specific billing guidance, providers should refer to the most current articles listed below:

Current Guidance

Previously published guidance is included below for reference:

Previously Published Vaccine Articles

Articles

Testing Guidance

Family PACT Guidance

Recipient Eligibility and Enrollment Guidance

Additional Guidance

Manual Sections

Other Resources