March 18, 2005

Medicare now accepts Part B pharmacy crossover claims for drugs in the HIPAA-mandated NCPDP 1.1 format; however, Medi-Cal currently does not. Medi-Cal is scheduled to begin accepting Part B pharmacy crossover claims for drugs in the NCPDP 1.1 format in October 2005. Until that time, providers who have converted to the NCPDP format with Medicare must continue billing the Medi-Cal portion of their crossover claims via the HCFA 1500 paper claim form using HCPCS codes (not National Drug Codes [NDCs]). To review crossover claim billing instructions, refer to the Medicare/Medi-Cal Crossover Claims: Pharmacy Services section of the Part 2 Pharmacy manual.

Additional details about Medi-Cal's implementation of the NCPDP 1.1 format will be published in future Medi-Cal Updates and on the Medi-Cal Web site.

For more information, call the Telephone Service Center (TSC) at 1-800-541-5555 and press the following option numbers (after selecting the appropriate language option):

• 14 (this option includes Medicare/Medi-Cal crossover claims), then
• 11 (this option is specific to Medicare/Medi-Cal crossover claims)