Originally published September 21, 2021
Updated on October 19, 2021
On October 19, 2021, Medi-Cal sent out a News article announcing that it can adjudicate electronic batch transaction (NCPDP 1.2), or pharmacy hard copy claim forms, when billing for the third dose of either the Pfizer-BioNTech or Moderna Coronavirus Disease 2019 (COVID-19) vaccines.
Previously, on September 3, 2021, Medi-Cal advised providers to hold claim submission for third doses of either the Pfizer-BioNTech or Moderna vaccines until appropriate system updates could be implemented to properly adjudicate claims.
As of the publication of this article, Medi-Cal can now accept Medical and Outpatient claims for the administration of a third dose of an applicable Coronavirus Disease 2019 (COVID-19) vaccine. Pharmacy claims may also be submitted. Pharmacy claims that are submitted via electronic batch transaction (NCPDP 1.2) or hard copy claim form may be suspended until further system updates can be made to Medi-Cal.
For the most current direction regarding billing guidelines for the respective manufacturers, including how to bill for the third dose, refer to the following COVID-19 vaccine web pages:
Providers with questions should contact the Telephone Service Center (TSC) Help Desk at 1-800-541-5555, 8 a.m. to 5 p.m., Monday through Friday, except holidays. Border providers and out-of-state billers billing for in-state providers, should call 1-916-636-1200.