Apple Health (Medicaid) Provider Alert
Attention providers:
What changed?
On April 23, 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 billing for COVID-19 vaccine administration.
Update to template billing - The Health Care Authority is waiting for approval from the Centers for Medicare & Medicaid Services (CMS) to allow template billing for COVID-19 mass vaccinations.
As soon as we have the approval, you will be able to submit claims via template billing if you are providing vaccines to MCO and FFS clients during a mass vaccination event.
We expect to have this approval soon and will send another notice informing you that template billing is allowed. Instructions for template billing are found in the ProviderOne Billing Guide under the Claim Template section.
Other options to bill for vaccines for fee-for-service clients are:
- Bill each individual claim. See instructions in ProviderOne Billing Guide under the Direct Data Entry section.
- Use batch 837. See instructions in ProviderOne Billing Guide under the Batch Submission (837) section.
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.
HCA published revisions to the Apple Health (Medicaid) COVID-19 vaccine clinical policy under Reimbursement information and billing guidance to reflect these updates.
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