Apple Health (Medicaid) Provider Alert
Attention providers:
Effective February 15, 2021, the Health Care Authority (HCA) published revisions to the Apple Health (Medicaid) COVID-19 vaccine clinical policy.
What changed?
Specifically:
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Pharmacists – Pharmacies may bill for COVID-19 vaccine administration when the performing provider is a pharmacist. See the Apple Health (Medicaid) COVID-19 vaccine clinical policy for specific billing details for fee-for-service (FFS) and HCA-contracted managed care organizations (MCO).
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Outpatient Prospective Payment System (OPPS) – When billing for the vaccine and the vaccine administration in an OPPS setting, use the location revenue code, not the vaccine administration revenue code. See the Apple Health (Medicaid) COVID-19 vaccine clinical policy for specific billing details.
These policies are applicable to both FFS providers and HCA-contracted MCOs.
COVID-19 Fee Schedule
See HCA’s Provider billing guides and fee schedules, under COVID-19, for HCA’s updated Emergency COVID-19 Fee Schedule which will be published on February 16, 2021.
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