DHCS claims for COVID-19 vaccine administration can be submitted, but will not be paid until system updates are made

January 04, 2021

On December 18, 2020, the California Department of Health Care Services (DHCS) announced its plan for reimbursement of the administration of the COVID-19 vaccine, but at that time advised physicians to hold their vaccine claims since its systems were not yet able to accept them.

While providers may now submit claims, DHCS says claims will not be processed until additional system changes are made, which isn’t expected until late January. Until then, the claims will appear in a “pending” status.

According to guidance released on December 29, 2020, while DHCS is taking steps to pend these claims, it’s possible that some claims may inadvertently be processed and denied. If denied, DHCS said claims will be reprocessed automatically through the Erroneous Payment Correction process once the system changes are implemented.

Practices should consider the pros and cons of submitting now vs. holding claims until the DHCS system updates are complete to determine what is right for their practice.

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