Providers Holding Submissions of Claims for COVID-19 Vaccine Administration May Now Submit

Originally published February 24, 2022
Updated on April 15, 2022

Update: FQHC, RHC, and Tribal FQHC providers may now submit claims to Medi-Cal. Billing instructions for affected providers are available in the April 15, 2022, article “FQHC, RHC and Tribal FQHC Providers May Now Submit Claims for COVID-19 Vaccine Administration”.

Information below was previously published on February 24, 2022.

Effective retroactively for dates of service on or after the respective dates for each approved COVID-19 vaccine, providers working with individuals in the following populations may receive reimbursement for administration of the coronavirus disease 2019 (COVID-19) vaccines:

  • Recipients in the Tuberculosis Program

  • Family PACT recipients

  • COVID-19 Uninsured Group recipients

Refer to the webpages below for billing guidance and effective dates for each vaccine:

Effective until December 31, 2022, Medi-Cal will waive the timeliness standard for vaccination administration claims by these providers when claims are submitted or resubmitted (electronically, or via hard copy) with the following:

  • Delay Reason Code “10”

  • Documentation indicating that the COVID-19 vaccine was administered are in the Remarks area of the submitted claim (for example, “COVID Vaccine administration”)

An Erroneous Payment Correction (EPC) will be implemented to reprocess any previously denied claims that were submitted by affected providers for the administration of an applicable COVID-19 vaccine. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described earlier in this article.

For instructions on how to submit or resubmit a claim with a delay reason code, see the following resources:

Previously, Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) providers were advised to hold claim submission for the administration of COVID-19 vaccines. FQHC and RHC providers are still advised to continue to hold claims. Providers will be notified when Medi-Cal is ready to accept claims from these providers.