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Do you know if non-contracted payors are complying with AB 72 interim payment rules?

July 26, 2022
Area(s) of Interest: Public Health 


The California Department of Health Care Services (DHCS) is now ready to accept Medi-Cal vaccine administration claims for individuals 6 months and older. Although COVID-19 vaccines for children under 5 were authorized for emergency use by the FDA in mid-June, DHCS had urged physicians to hold Medi-Cal claims for vaccine administration for small children because DHCS had not completed the system and operational changes required to correctly pay the claims.

As of July 25, 2022, the Medi-Cal claims adjudication system is now prepared to appropriately process claims for all age groups.

As a reminder, DHCS carved out COVID-19 vaccine administration reimbursement from the Medi-Cal managed care system and is reimbursing under the fee-for-service delivery system for both medical and pharmacy claims.

For more information on submitting COVID-19 vaccine administration claims, see the DHCS COVID-19 Medi-Cal Response webpage. For more information on COVID-19 billing and reimbursement, see the California Medical Association’s COVID-19 Vaccine Toolkit for Medical Practices and COVID-19 Vaccine Reimbursement Quick Guide.

 

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