COVID-19 Vaccine Administration: Real-Time RTIP Pharmacy Claims Can Be Submitted

Originally published January 4, 2021
Updated on March 3, 2021
Note:
Most recent updates are denoted with two plus signs (++)

This is the eighth article in the COVID-19 Vaccine Administration series and informs pharmacy providers that they may begin submitting real-time claims via the Real Time Internet Pharmacy (RTIP) claim submission system for the COVID-19 vaccine administration.

Medi-Cal requests pharmacy providers to remain aware of the below highlights as they begin submission. Clarification on system changes, reimbursement, and timelines has been added.

  • ++The Food and Drug Administration (FDA) has provided Emergency Use Authorization (EUA) for the following vaccine manufacturers:

  • As other vaccine manufacturers are approved by the FDA, additional billing instructions will be issued. Providers should refer to the COVID-19 Medi-Cal Response page for specific billing information for approved vaccines.

  • System and operational changes are required to enable successful claims adjudication.

    • The system changes for real-time RTIP pharmacy claims submission are live in production as of Monday, January 4, 2021.

    • These changes enable reimbursement for the administration of dose 1 at the Medicare allowable rate of $16.94, and the administration of dose 2 at the Medicare allowable rate of $28.39.

++In the original publication of this article, providers planning to submit claims via batch electronic formats (NCPDP 1.2), or the Pharmacy Claim Form (30-1) were instructed to continue to hold their claims until further notice. Since then, instructions on how to properly bill for both, are available in the January 13, 2021, article titled “COVID-19 Vaccine Administration: Preparing NCPDP 1.2 and Pharmacy Hard Copy Submissions”.

As of January 19, 2021, all pharmacy claim submission types can be submitted to Medi-Cal:

++For the most current direction regarding whether or not claims should be submitted, and what behavior to expect when submitting, providers should refer to the “Pharmacy Claim Submissions” and “Medical and Outpatient Claim Submissions” tables on the COVID-19 Medi-Cal Response page.