The California Department of Healthcare Service (DHCS) has just posted an update regarding Medi-Cal Rx transition (See Related Blog Post). In anticipation of this transition, there are some early cutoff activities that California pharmacies should note:
- Pharmacy Paper Claim Submitters: The cutoff for claims processing for paper claim submissions to the current FI is March 14, 2021. Paper claim submissions received after this date will be routed to Medi-Cal Rx for processing on April 1, 2021.
- Pharmacy Claim Inquiry Forms (CIFs) and Appeals: The cutoff for the receipt of pharmacy CIFs and Appeals to the current FI is March 14, 2021. Submissions received after this date will be routed to Medi-Cal Rx for processing on April 1, 2021.
- Pharmacy Computer Media Claim (CMC) Batch Submitters: The cutoff for the receipt of pharmacy CMC submissions is March 14, 2021 at 11:59 p.m. CMC claims sent to the current FI on or after March 14, 2021 will be rejected. For batch claim submissions after this cutoff, DHCS recommends that submitters prepare these files per the Medi-Cal Rx Payer Sheet and then hold the files and submit them to Medi-Cal Rx on or after April 1, 2021.
- Pharmacy Treatment Authorization Request (TAR) Fax Lines: The existing pharmacy TAR fax lines (800-869-4325, 800-371-0712, 800-829-4325, 800-641-1021, 213-346-9424, 209-933-9593) will be shut down on March 31, 2021 at 5:00 p.m. These numbers will be transitioned to Medi-Cal Rx and are scheduled to be available for Fax Prior Authorizations and attachments for Medi-Cal Rx on April 1, 2021.
- Pharmacy TAR Fax Attachment Line: The existing free-form attachments for the electronic TAR fax line (877-270-8779) will continue to operate for non-carved out pharmacy services and medical services. As of April 1, 2021, the pharmacy free-form attachments line for Medi-Cal Rx is 800-869-4325.
For more information, visit Medi-Cal Rx website.