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One Week Left to Complete the Medi-Cal Pharmacy Provider Self-Attestation

February 21, 2018

The online attestation portal for fee-for-service Medi-Cal pharmacy providers seeking the higher of two professional dispensing fees as part of the forthcoming reimbursement changes for covered outpatient drugs closes in one week, at 12 a.m. on March 1, 2018. Attestations will not be accepted after that time.

As has been published in previous Medi-Cal Updates, the Department of Health Care Services (DHCS) is implementing a new fee-for-service reimbursement methodology for covered outpatient drugs. Part of this new methodology is a two-tiered professional dispensing fee based on a pharmacy provider’s total (Medi-Cal and non-Medi-Cal) annual pharmacy claim volume ($13.20 if fewer than 90,000 claims per year; $10.05 if 90,000 or more). Reporting the claim volume is a self-attestation process, which is submitted electronically and must be done annually.

Note:

DHCS policy is that a claim is equivalent to a dispensed prescription; therefore, the attestation is for the total dispensed prescription volume.

Only fee-for-service Medi-Cal providers dispensing fewer than 90,000 total prescriptions per calendar year are eligible to receive the higher of the two professional dispensing fees and must complete this attestation in order to receive it.

The attestation period for both the 2016 and 2017 calendar years opened January 15, 2018, and closes at 12 a.m. on March 1, 2018. Separate attestations must be submitted for each calendar year. The attestation for each calendar year reporting period determines the professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service within the State’s following fiscal year. As an example, a 2017 calendar year claim volume attestation determines the professional dispensing fee for claims within the State’s 2018 – 2019 fiscal year (dates of service of July 1, 2018, through June 30, 2019).

For additional information, providers can refer to the Pharmacy Provider Self-Attestation FAQs or the Pharmacy Reimbursement Project page on the DHCS website. For inquiries not covered in either, providers may call the Telephone Service Center at 1-800-541-5555 and select the following options:

  1. Option 1 for English or Option 2 for Spanish
  2. Option 1 for Provider
  3. Option 4 for Technical Help Desk
  4. Option 2 for Pharmacy
  5. Option 1 for Provider
  6. Option 1 for NPI (enter NPI followed by the # sign)
  7. Option 2 for Pharmacy

After following the steps above, the caller will be directed to an agent.