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