CMA urges state to push payors to proactively prepare for pediatric COVID-19 vaccine admin claims

October 26, 2021

The California Medical Association (CMA) this week sent letters to the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) asking the agencies to encourage payors to proactively prepare their claims processing systems to correctly process COVID-19 vaccine administration claims from day one for newly eligible populations, particularly for the anticipated approval of the 5–11-year-old pediatric vaccine.

Some payors have thus far been slow to update their systems to process vaccine administration claims correctly, resulting in claim denials and leaving physicians with no reimbursement for the services provided to newly eligible patients. While the problems have eventually been identified and corrected, the lack of preparedness creates administrative and financial barriers for the physician community to administer COVID-19 vaccines. Addressing these barriers is critical to getting more individuals vaccinated.

View CMA’s letter here.


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