On April 1, 2021, the online attestation period 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. By April 1, 2021, Medi-Cal pharmacy providers should have received a communication that includes the URL for the online attestation portal, as well as a unique login ID and password, by email, fax, or mail. If you have not received this communication, please call the Attestation Survey Hotline at 1-844-294-9982 or email CODSurvey@mercer.com.
As 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 is submitted electronically and must be repeated annually.
DHCS policy states that a claim is equivalent to a dispensed prescription; therefore, the attestation is 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 2020 calendar year is open from April 1, 2021, to April 30, 2021. The attestation period ends at 11:59 p.m. on April 30, 2021, and no attestations will be accepted after that time. The attestation for the 2020 calendar year reporting period determines the professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service from July 1, 2021, through June 30, 2022.
For additional information, providers can refer to the Pharmacy Provider Self-Attestation FAQs, or may call the Attestation Survey Hotline at 1-844-294-9982, or email their questions to CODSurvey@mercer.com.