Updates to the COVID-19 vaccine clinical policy

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Apple Health (Medicaid) Provider Alert

Attention providers:

What changed?

  • Family Planning Only clients - Retroactive to dates of service on and after April 1, 2021, COVID-19 vaccine administration is a covered service for Family Planning Only clients.
  • Roster billing for COVID-19 vaccine administration – The Health Care Authority (HCA) is implementing a system change to allow for roster billing for COVID-19 vaccine administration. The system change will be in place by May 1, 2021. Please see the ProviderOne Billing and Resource Guide for instructions on how to create a claim template and to submit template billing. This policy is retroactive to dates of service on and after April 1, 2021. However, do not bill until May 1, 2021 and after.

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 to reflect these updates