Updates to the COVID-19 vaccine clinical policy

Washington State Health Care Authority sent this bulletin at 04/23/2021 11:05 AM PDT

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Apple Health (Medicaid) Provider Alert

Attention providers:

What changed?

On April 13, 2021, the Health Care Authority (HCA) sent a Provider Alert informing providers about updates to the COVID-19 vaccine clinical policy. This notice revises the information sent regarding the roster billing for COVID-19 vaccine administration.

When billing for vaccines for fee-for-service clients, you have three options:

Bill each individual claim. See instructions in the ProviderOne Billing Guide under the Direct Data Entry (DDE) in ProviderOne section.
Use batch 837. See instructions in the ProviderOne Billing Guide under Submitting online batch claims section (HIPAA Batch Transaction 837).
Template billing. See instructions in the ProviderOne Billing Guide under Claim templates section.

Note: HCA is in the process of removing the requirement for a servicing provider on vaccine claims. The system change will be in place by May 1, 2021. This policy is retroactive to date of services on and after April 1, 2021. However, do not bill until May 1, 2021, and after.

In addition, HCA is no longer requesting that you bill the vaccine with the vaccine administration code. If you do submit a claim with both codes, HCA will not pay for the vaccine, but will pay for the administration of the COVID-19 vaccine.

These policies are applicable to both fee-for-service (FFS) providers and HCA-contracted managed care organizations (MCOs).

HCA published revisions to the Apple Health (Medicaid) COVID-19 vaccine clinical policy under Reimbursement information and billing guidance to reflect these updates.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Updates to the COVID-19 vaccine clinical policy

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination