COVID-19 Vaccine Administration: COVID-19 Uninsured Group – Vaccine Reimbursement

Originally published December 22, 2020
Updated on January 6, 2021

This is the second article in the COVID-19 Vaccine Administration series. With the recent federal approval of COVID-19 vaccines, the Department of Health Care Services (DHCS) is seeking federal approval to help support delivery of the vaccine to all Medi-Cal beneficiaries.

Effective November 2, 2020, Qualified Providers (QPs), who are also registered with the California Department of Public Health as a COVID-19 Vaccination Provider, can be reimbursed for the COVID-19 vaccine through the COVID-19 Uninsured Group Program.

QPs should refer to the previously published article titled “COVID-19 Vaccine Administration: Initial and Upcoming Policy,” for specific billing instruction and policies regarding the reimbursement for the administration of the COVID-19 vaccine.

Additionally, as a reminder, individuals who have a Medi-Cal Share of Cost (SOC), and have not met their SOC obligation, are eligible for the COVID-19 Uninsured Group Program if all other eligibility criteria are met. The COVID-19 Uninsured Group program provides temporary, no cost diagnostic testing, testing-related services, hospitalization and other treatment and vaccination services, including all medically necessary care, which includes associated office, clinic, or emergency room visits related to COVID-19. This program is available to uninsured and underinsured individuals determined eligible by a QP based on preliminary applicant information. Providers should refer to the COVID-19 Uninsured Group’s Frequently Asked Questions for more information.

QPs of the PE4PW, BCCTP, HPE, or CHDP Gateway programs will have access to the COVID-19 Uninsured Group Application Portal.

To access the COVID-19 Uninsured Group Application Portal, follow the instructions below:

  1. Access the Medi-Cal website at https://www.medi-cal.ca.gov/, select “Providers” and click the “Transactions” link.

  2. Enter your User ID (National Provider Identifier) and Password (Provider Identification Number) and click the “Submit” button.

  3. Click the “Prgms” tab.

  4. Click the “COVID-19 Uninsured Group Eligibility” link.

Questions

For billing related questions, please contact the Telephone Service Center (TSC) at 1(800) 541-5555. The TSC is available 8 a.m. to 5 p.m., Monday through Friday, except holidays (border providers and out-of-state billers billing for in-state providers, call [916] 636-1200).

For other general questions concerning the COVID-19 Uninsured Group program, please direct your inquiry to COVID19Apps@dhcs.ca.gov.