Apple Health (Medicaid) Provider Alert
Attention providers:
What has changed?
The Health Care Authority (HCA) is now allowing template billing for COVID-19 mass vaccination. This policy is retroactive to claims with dates of service on and after April 1, 2021.
What is a mass vaccination?
HCA considers a mass vaccination a time during which the provider is administering the COVID-19 vaccines to many people.
Who can bill using template billing?
During the public health emergency (PHE), HCA is allowing providers to submit template billing claims through ProviderOne, for both fee-for-service and agency-contracted managed care organization (MCO) clients. This is the only time/situation that a provider is allowed to bill using ProviderOne for a managed care client.
How do I bill using template billing?
When submitting template billing, the servicing provider must be included on the claim.
Exception: The exception to this rule is if the servicing provider is a volunteer. If the servicing provider is a volunteer, then only the billing provider is required to be included on the claim. A volunteer under this circumstance must: (1) have vaccine administration within their scope of practice; (2) be someone who not typically linked to your organization; and (3) not be being paid for the service.
See HCA’s COVID-19 vaccine claim template billing (PowerPoint presentation) or in HCA’s ProviderOne Billing & Resource Guide in the template billing section.
HCA has published a revised Apple Health (Medicaid) COVID-19 vaccine clinical policy.
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