Title
Alcohol Wipes Billing Code Update
MAPC update for HCPCS code A4245 in List of Medical Supplies Billing Codes, Units and Quantity Limits.
PH 
Pharmacy
12/03/2021
March Virtual Claims Assistance Room (CAR) Event
Virtual Claims Assistance Room (CAR) Event is scheduled for March.
Claims, Outreach and Education
12/01/2021
Incontinence Product List Correction
UPN in The List of Contracted Incontinence Products will be corrected.
PH 
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, System
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.
PH 
Pharmacy, DHCS Notice
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.
HOM 
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, System
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, DHCS Notice
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.
CAH, GM, OB, PH 
COVID-19, Programs
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, Billing
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, DHCS Notice
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, Billing
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, DHCS Notice
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, Provider Enrollment
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, Billing
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, DHCS Notice
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, DHCS Notice
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, DHCS Notice
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.
CAH, GM, OB 
Every Woman Counts, Claims
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