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Reminder: Claims for Emergency Services

February 13, 2017

Emergency pharmacy services are exempt from prior authorization. Emergency Services claims cannot be billed through the Point of Service (POS) network or Computer Media Claims (CMC) format. Claims may be submitted with an Emergency Certification Statement. The Emergency Certification Statement must be attached to the Pharmacy Claim Form (30-1) and include:

  • The nature of the emergency, including relevant clinical information about the patient's condition
  • Why the emergency services rendered were considered to be immediately necessary
  • The signature of the physician, podiatrist, dentist or pharmacist who had direct knowledge of the emergency

The statement must be comprehensive enough to support a finding that an emergency existed. A mere statement that an emergency existed is not sufficient.

An Emergency Certification Statement may not be used in place of a Treatment Authorization Request (TAR) for diabetic supplies that require authorization when the maximum quantity has been reached. For further information, see the List of Contracted Diabetic Test Strips and Lancets spreadsheet on the Medi-Cal website.

Providers may contact the Telephone Service Center (TSC) at 1-800-541-5555 or Northern and Southern Pharmacy Sections at 1-866-385-3124 for questions and inquiries related to pharmacy services.