COVID-19 Vaccine Administration: Medical and Outpatient Claims Now Adjudicating

January 25, 2021
Updated on March 3, 2021
Most recent updates are denoted with two plus signs (++)

This is the eleventh article in the COVID-19 Vaccine Administration series and informs medical and outpatient providers that electronic and hard copy claims that have been submitted since December 29, 2020, are now being processed and undergoing adjudication. Providers should begin to see reimbursements via Electronic Fund Transfer (EFT) or checkwrite payment once claims are properly processed.

Providers submitting vaccine administration claims for recipients who have Other Health Coverage (OHC) will continue to see submissions appear in “pending” status for a period of time. System changes to properly adjudicate these claims are being actively worked upon, and updates will be provided via a different News article once they are available.

Note for all medical and outpatient claims: claims for the administration of the COVID-19 vaccine that were previously submitted prior to this notification and subsequently inadvertently denied or processed incorrectly instead of being put into “pending” status, will be automatically reprocessed via Erroneous Payment Correction (EPC) in the future.

++Medical and outpatient providers searching for instructions on how to submit claims electronically or via hard copy may find information on the respective vaccine pages:

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.

Further information regarding when medical and outpatient providers could have begun submitting claims, is available in the News article titled “COVID-19 Vaccine Administration: Medical and Outpatient Claims Can Be Submitted.”

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.