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Medi-Cal News Articles

Title

Category

Publish Date

Eligibility of COVID-19 Booster Doses Expanded to All Adults

Medi-Cal can now adjudicate the administration of a booster dose to individuals 18 years of age and older who received the second dose of their primary vaccination series at least six months ago.

COVID-19

11/23/2021

Multi-Purpose Senior Services Program Update

Major organ transplants will be able to enroll or continue enrollment in Medi-Cal managed care in all counties.

Programs

11/23/2021

Major Organ Transplants Update for Managed Care Plan Beneficiaries

Major organ transplants will be able to enroll or continue enrollment in Medi-Cal managed care in all counties.

Programs

11/22/2021

Multi-Purpose Senior Services Program Update

Major organ transplants will be able to enroll or continue enrollment in Medi-Cal managed care in all counties.

Programs

11/22/2021

Reimbursement of COVID-19 Vaccine and Monoclonal Antibody Administration for Medical Providers

This article details the administration and reimbursement of COVID-19 vaccines and monoclonal antibodies when administered as Physician Administer Drugs (PADs) by medical providers.

Billing

11/17/2021

February 2022 Medi-Cal Provider Training Webinars

Outreach and Education along with the Department of Health Care Services is offering category specific webinar sessions in February.

Outreach and Education

11/15/2021

Cal AIM Transition

CalAIM initiative to standardize enrollment process to help ensure populations moving between counties are subject to the same enrollment requirements.

Provider Enrollment

11/15/2021

Update Medi-Cal Rx NCPDP Payer Specification Sheet Now Available

Updated payer sheet available on the Medi-Cal Rx Web Portal.

Pharmacy

11/09/2021

Shared Nursing Services are Reimbursable with Modifier TT

Providers can bill for shared nursing services with HCPCS codes S9123 and S9124 with modifier TT.

Billing

11/08/2021

Safety Net Clinic Billing Instructions for CalAIM Dental Initiatives Forthcoming

CalAIM will be implemented with dental initiatives including pay-for-performance payments for preventive services and continuity of care/establishing a dental home, and two new program benefits.

Billing

11/08/2021

Pfizer-BioNTech COVID-19 Vaccine for Children 5 through 11 Can Be Processed

Medi-Cal can now adjudicate the administration of a primary vaccination series in children 5 thru 11 years of age.

COVID-19

11/05/2021

Coming Soon: Pfizer-BioNTech COVID-19 Vaccine is Authorized for Children 5 through 11

The FDA has amended the Pfizer-BioNTech COVID-19 vaccine EUA to allow for the administration of a reduced dose primary vaccination series in children 5 thru 11 years of age. However, Medi-Cal still requires system updates to support adjudication.

COVID-19

11/04/2021

Pregnancy Eligibility During the Covid-19 Public Health Emergency (PHE)

Beneficiaries in pregnancy related aid codes continue to remain eligible for non-pregnancy related services during this health crisis, beyond the end of their pregnancy through the duration of the PHE.

COVID-19

11/03/2021

Booster Dose for Pfizer-BioNTech COVID-19 Vaccine Can Be Processed

Medi-Cal can now accept all claims for a Pfizer-BioNTech COVID-19 booster dose.

COVID-19

10/29/2021

Coming Soon: Booster Dose for Janssen COVID-19 Vaccine is Authorized

While the FDA has amended the Janssen COVID-19 vaccine EUA to allow for the administration of a booster dose, Medi-Cal still requires system updates to support adjudication.

COVID-19

10/29/2021

Booster Dose for Moderna COVID-19 Vaccine Can Be Processed

The FDA has amended the Moderna COVID-19 vaccine EUA to allow for the administration of a booster dose. Medi-Cal can accept all claims for a booster dose, although Outpatient claims may suspend until further notice.

COVID-19

10/29/2021

Booster Dose for Janssen COVID-19 Vaccine Can Be Processed

Medi-Cal can now accept most Medical, Outpatient, and Pharmacy claims for the administration of a booster Janssen COVID-19 vaccine.

COVID-19

10/29/2021

California Kids Care is No Longer a Medi-Cal Managed Care Plan

California Kids Care will no longer be a Managed Care provider effective January 2022.

DHCS Notice

10/27/2021

Heterologous (Mix and Match) COVID-19 Vaccine Booster Doses are Authorized

The FDA has amended various COVID-19 vaccine EUAs to allow for the administration of a heterologous (mix and match) booster dose to eligible populations.

COVID-19

10/26/2021

New Electronic Claim Resubmission Helps Providers Avoid Paper CIFs/Appeals

Better understand how to electronically replace or void already processed 837 Institutional and Professional claims. A way to fix claim issues without needing paper Claims Inquiry Forms Remittance Advice Details or Appeal Forms.

Billing

10/26/2021

Coming Soon: Booster Dose for Pfizer-BioNTech COVID-19 Vaccine is Authorized for Certain Populations

The Food and Drug Administration amended the Emergency Use Authorization for the Pfizer BioNTech COVID-19 vaccine to allow for use of a single booster dose for certain populations.

COVID-19

10/26/2021

Transportation Treatment Covered for COVID-19 Uninsured Group Restricted Scope

DHCS reminds providers of the scope of coverage that individuals in the COVID-19 Uninsured Group are eligible for, including transportation and various COVID-19 related treatment services.

COVID-19

10/25/2021

Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines: Pharmacy Batch and Hard Copy Claims

Medi-Cal is now able to properly process and adjudicate Pharmacy electronic batch or hard copy claims for the third dose of either the Pfizer-BioNTech and Moderna COVID-19 vaccines.

COVID-19

10/25/2021

Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Can Be Processed

Medi-Cal can now accept Medical and Outpatient claims for the administration of a third dose of an applicable COVID-19 vaccine.

COVID-19

10/25/2021

Sending EWC Paper Claims to the Correct Address

Providers are reminded to mail claims to the CAMMIS FI. Claims submitted to the EWC Office will not be processed.

Every Woman Counts

10/22/2021

FQHC/RHC Annual Rate Adjustment Correction

DHCS posted a bulletin informing FQHCs and RHCs of a 1.4 percent rate increase to reflect the current MEI. These rates were erroneously updated at 1.9 percent and being corrected.

Billing

10/21/2021

COVID-19 Uninsured Group Program Off-Premise Flexibilities

PE providers are allowed to complete determinations for COVID-19 PE, off the premises of hospitals and clinics. They may also use third-party vendors to help complete applications.

COVID-19

10/21/2021

Reminder Flowcharts Must Accompany TARs Submitted for Therapeutic Anti-Decubitus Mattresses and Bed Products

All initial and reauthorization Treatment Authorization Requests (TARs) for support surfaces must be accompanied by the appropriate flowchart(s) found in the Therapeutic Anti-Decubitus Mattresses and Bed Products section of the Medi-Cal Provider Manual.

eTAR and TAR

10/20/2021

Filing Window: Marriage and Family Therapist Visits for FQHC/RHC Providers

Newsflash to alert providers of a timely filing window for marriage and family therapist visits for FQHC/RHC providers. Retroactively for dates of service January 1, 2018 through July 12, 2021.

Billing

10/15/2021

Extension of Grace Period Related to Four Walls Requirement for IHS/Tribal Facilities

The grace period previously granted to Indian Health Service (IHS) and Tribal facilities related to the “Four Walls” Requirement is extended to conclude nine months after the end of the COVID-19 Public Health Emergency (PHE).

COVID-19

10/15/2021

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Part 1 - Medi-Cal Program & Eligibility Bulletin

Allied Health Bulletins

Acupuncture (ACU)

Audiology and Hearing Aids (AUD)

Chiropractic (CHR)

Durable Medical Equipment and Medical Supplies (DME)

Medical Transportation (MTR)