Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Medi-Cal Logo
Click to Sign Up for MCSS emails

Medi-Cal Pharmacy Provider Self-Attestation Portal Now Open

January 17, 2020

On January 15, 2020, the online attestation portal opened for fee-for-service Medi-Cal Pharmacy providers seeking the higher of two professional dispensing fees as part of the reimbursement for covered outpatient drugs. During the second week of January 2020, Medi-Cal Pharmacy providers should have received a mailer that includes the URL for the online attestation portal as well as a unique login ID and password.

As has been published in previous Medi-Cal Updates, the Department of Health Care Services (DHCS) has implemented 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 calendar year 2019 is open from January 15, 2020, through February 29, 2020. The web portal will close at 11:59 p.m. on February 29, 2020, and attestations will not be accepted after that time. The attestation for the 2019 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, 2020, through June 30, 2021).

For additional information, providers may refer to the Pharmacy Provider Self-Attestation FAQs on the Medi-Cal website or the Pharmacy Reimbursement Project page of the DHCS website. For inquiries not covered in the FAQs, providers may call the Telephone Service Center at 1-800-541-5555, or (916) 636-1960 if calling outside of California, 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.