Booster Dose for Janssen COVID-19 Vaccine Can Be Processed

October 29, 2021

Previously, on October 26, 2021, Medi-Cal advised providers to hold claim submission for booster doses of the Janssen vaccine until appropriate system updates could be implemented to properly adjudicate claims.

As of the publication of this article, Medi-Cal can now accept most Medical, Outpatient, and Pharmacy claims for the administration of a booster Janssen COVID-19 vaccine.

  • Medical and outpatient providers may submit via either electronic or hard copy methods; whatever suits their preference.

  • Pharmacy providers may only submit via NCPDP D.0 or RTIP at this time. Providers wishing to submit claims to Medi-Cal via NCPDP 1.2 (batch) or hard-copy claim methods, should hold their claims until further notice.

DHCS is aggressively pursuing the necessary required system changes to support the adjudication of the batch and hard-copy Pharmacy claims and will inform providers when the system is ready to process NCPDP 1.2 or hard-copy submission methods.

For the most current direction regarding eligible populations and booster dose billing guidelines, refer to the Janssen COVID-19 Vaccine web page.

Additionally, effective for dates of service on or after October 20, 2021, eligible individuals may choose which vaccine they receive as a booster dose. The eligible population(s) and dosing interval for the heterologous (mix and match) booster dose are the same as those authorized for a booster dose of the vaccine used for primary vaccination. Medi-Cal is prepared to receive claims for the administration of a heterologous booster dose for the Moderna or Pfizer-BioNTech COVID-19 vaccines, and providers are encouraged to bill at their earliest convenience.

Billing and eligibility guidelines for booster doses are available on the Pfizer-BioNTech COVID-19 Vaccine, Moderna COVID-19 Vaccine, or Janssen 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.