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Medi-Cal Pharmacy Provider Self-Attestation Ends February 28

February 22, 2019

The online attestation portal for fee-for-service Medi-Cal pharmacy providers seeking the higher of two professional dispensing fees for covered outpatient drug claims within the state’s next fiscal year (2019 – 2020) closes at 11:59 p.m. on February 28, 2019.

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 must be submitted electronically and must be repeated 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 the 2018 calendar year opened January 15, 2019, and closes at 11:59 p.m. on February 28, 2019. Attestations will not be accepted after that time. The attestation for the 2018 calendar year reporting period will determine the professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service within the state’s following fiscal year (dates of service from July 1, 2019, through June 30, 2020).

For additional information, providers can refer to the Pharmacy Provider Self-Attestation FAQs on the Medi-Cal website 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 (outside of California, call [916] 636-1980), 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 pound key (#)

  7. Option 2 for Pharmacy

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