1. New NDC for Moderna COVID-19 Vaccine
Moderna has introduced a new National Drug Code (NDC), 80777027315, for their coronavirus disease 2019 (COVID-19) vaccine. Medi-Cal will accept and adjudicate pharmacy claims for dates of service on or after April 1, 2021, that use this NDC when billing for the administration of either dose of the Moderna COVID-19 vaccine.
The Moderna COVID-19 Vaccine web page is updated to reflect this change. All other billing policy, regardless of NDC billed, remains unchanged.
2. New Provider Type: Tribal Federally Qualified Health Centers
Effective for dates of service on or after January 1, 2021, State Plan Amendment (SPA) 20-0044 establishes Tribal Federally Qualified Health Centers (Tribal FQHCs) as a new Medi-Cal provider type.
Under Section 1905(l)(2)(B) of the Social Security Act, outpatient health care programs operated by a tribe or tribal organization under the Indian Self-Determination and Education Assistance Act (ISDEAA), Public Law 93-638, are eligible to enroll as a Tribal FQHC in Medi-Cal. Tribal FQHCs provide covered primary care clinic services to Medi-Cal patients. Tribal FQHC services may be provided in a clinic or off site by tribal providers and non-tribal providers that are contractors of the Tribal FQHC. Reimbursement for Tribal FQHCs is through an Alternative Payment Methodology (APM), which is set at the federal Indian Health Service All-Inclusive Rate (AIR).
Tribal health clinics operating under the authority of the ISDEAA may request designation as a Tribal FQHC by completing an “Elect to Participate” Indian Health Services Memorandum of Agreement (IHS/MOA) and Tribal Federally Qualified Health Center (FQHC) (form DHCS 7108).
New Provider Manual Sections
Program policy and billing code information are included in the new Tribal Federally Qualified Health Centers (Tribal FQHCs) and Tribal Federally Qualified Health Centers (Tribal FQHCs): Billing Codes sections of the appropriate Part 2 Medi-Cal provider manuals.
3. Medi-Cal Rx Subscription Service and Pharmacy Service Representative Phone Campaign
In preparation for the eventual transition of pharmacy claim administration to Medi-Cal Rx, the Medi-Cal Rx Subscription Service (MCRxSS) is available and the Pharmacy Service Representative Phone Campaign has been activated for all Medi-Cal Rx providers, including pharmacies, prescribers and their staff.
Medi-Cal Rx Subscription Service
The MCRxSS is a free service that provides the latest Medi-Cal Rx news, including upcoming training and outreach events. Current Medi-Cal providers, pharmacies, prescribers and their staff are encouraged to sign up for MCRxSS to stay informed of the latest pharmacy news. Subscribers will receive subject-specific emails for urgent announcements and other updates shortly after they are posted to the Medi-Cal Rx website. Individuals can sign-up for this service at the following address on the MCRxSS sign up page on the DHCS website.
Pharmacy Service Representative Phone Campaign
Pharmacy Service Representatives (PSRs) will be reaching out to prescribers via a phone call to introduce the new Medi-Cal Rx website and its available resources. If you are a prescriber and have started the User Administration Console (UAC) registration process, but have not completed it, please anticipate a phone call from a PSR to assist and answer questions. The PSRs will provide guidance on how to start registration for the secure provider portal and inform prescribers of available training and resources for Medi-Cal Rx.
4. Medi-Cal Rx Pharmacy Provider and Prescriber Readiness Survey
How do you and your peers currently conduct business for Medi-Cal Pharmacy Claims?
In preparation for the eventual transition of pharmacy claim administration to Medi-Cal Rx, the Medi-Cal Rx Education & Outreach Team would love to hear from you! The results of the Medi-Cal Rx Pharmacy Provider & Prescriber Readiness Survey will be used to tailor our training offerings for Medi-Cal Rx to ensure you are prepared for the upcoming transition. The information you provide is confidential and will be used only for future training.
5. Get the Latest Medi-Cal News: Subscribe to MCSS Today
The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.
Subscribing is simple and free!
- Go to the MCSS Subscriber Form
- Enter your email address and ZIP code and select a subscriber type
- Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts
After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.
For more information about MCSS, please visit the MCSS Help page.
6. Provider Manual Revisions
Pages updated due to ongoing provider manual revisions:
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