Title
Category
Publish Date
Safety Net Clinic Billing Instructions for CalAIM Dental Initiatives
DHCS will implement the CalAIM dental initiatives statewide: pay-for-performance payments for preventive services and continuity of care/establishing a dental home.
Billing
12/08/2021
Managed Care Plan Program Updates
Updates to the MSSP and Major Organ Transplants Managed Care Programs.
Programs
12/08/2021
Postpartum Care Expansion
An individual eligible for pregnancy and postpartum care services under MCAP is entitled to an additional ten months postpartum coverage at the end of their 60-day postpartum period for a total 12 months of postpartum coverage.
COVID-19
12/08/2021
Alcohol Wipes Billing Code Update
MAPC update for HCPCS code A4245 in List of Medical Supplies Billing Codes, Units and Quantity Limits.
Pharmacy
12/03/2021
March Virtual Claims Assistance Room (CAR) Event
Virtual Claims Assistance Room (CAR) Event is scheduled for March.
Claims
12/01/2021
Incontinence Product List Correction
UPN in The List of Contracted Incontinence Products will be corrected.
Pharmacy
12/01/2021
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

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