Update to Medi-Cal Rx Support Services and Key Payer Sheet Details

August 28, 2020

The Department of Health Care Services (DHCS) is delaying the planned Go-Live date of April 1, 2021 for Medi-Cal Rx. For more information, please read this publication.

In April 2020, DHCS began publishing a series of articles regarding the upcoming Medi-Cal Rx transition. The transition of all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries, Medi-Cal fee-for-service (FFS) or Managed Care Plans (MCPs), to the new Medi-Cal Rx vendor, Magellan Medicaid Administration, Inc. (Magellan), goes into effect January 1, 2021.

This article provides an update on Medi-Cal Rx support services and key payer sheet details so that pharmacy providers and their billing agents can begin incorporating changes into their processes and technical solutions.

Provider Support Services

As outlined below, initial support services will be provided through portal and email inquiry services, as well as published transition forums. As other support services are launched, notifications will be issued to alert the provider community.

Medi-Cal Rx Support Prior to January 1, 2021

For information on Medi-Cal Rx, visit the Provider Portal on www.Medi-CalRx.dhcs.ca.gov or the DHCS Medi-Cal Rx Transition page. For general questions relating to Medi-Cal Rx, please direct your comments and questions to RxCarveOut@dhcs.ca.gov.

Medi-Cal Rx Customer Service Center starting January 1, 2021

Magellan Medicaid Administration (MMA) will implement a Medi-Cal Rx Customer Service Center to assist providers (including but not limited to pharmacists and prescribers) and beneficiaries.

The Medi-Cal Rx Customer Service Center will be available starting January 1, 2021. The toll-free number for the Customer Service Center, 1.800.977.2273, will be available 7 days a week, 24 hours a day and 365 days a year beginning on January 1, 2021. The telephone menu options are included below to allow providers to update processes and any automation that they may have in place.

Nationwide Toll-Free Number: 1.800.977.2273

Main Menu Options:

  • For Beneficiaries, press 1

  • For Pharmacies, press 2

  • For Prescribers, press 3

  • For authorized MCP representatives, press 4

  • For TTY callers, press 5

  • All other callers, press 6

Medi-Cal Rx customer service representatives will be able to respond to questions that include, but are not limited to the following:

  • Claims processing/messaging

  • Drug Coverage

  • Beneficiary eligibility

For beneficiaries dually enrolled in Medicaid and Medicare, beneficiaries should be directed to 1-800-Medicare (1-800-633-4227) or to the help desk of their Medicare Part D prescription drug plan.

Please note that prior to January 1, 2021, for general questions about Medi-Cal Rx, providers should contact the general Medi-Cal Telephone Service Center (TSC) at 1-800-541-5555, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Payer Sheet Details

As key Medi-Cal Rx payer sheet specifics are finalized they are being communicated in advance of formalized documentation so pharmacy providers and their agents can begin making changes. Specifics regarding the beneficiary identification (ID) number, Banking Identification Number (BIN), and Processor Control Numbers (PCNs) for the different pharmacy transactions are referenced below.

Beneficiary ID

The Medi-Cal Program issues a Benefits Identification Card (BIC) to all beneficiaries, both FFS and Managed Care enrollees. For beneficiaries who are enrolled in a Medi-Cal MCP, a plan specific identification card is also issued.

For Medi-Cal Rx, pharmacy providers are expected to utilize the 14-character beneficiary identification number located on the front of the BIC or the 9-character Client Index Number (CIN) which is the same as the first nine characters of the beneficiary identification number. MCP identification cards and associated ID numbers cannot be used for Medi-Cal Rx billing.

Same-day new Medi-Cal enrollments will require the 14-character (BIC) for services rendered on that enrollment day.

Below is a graphic of the current BIC for your reference.

Example of a California BIC card.

BINs and PCNs

Medi-Cal Rx will issue a National Council for Prescription Drug Programs (NCPDP) Standard Payer Sheet in a future publication. To enable pharmacy providers and electronic submitters to begin planning for system and/or software updates, Medi-Cal Rx is releasing the BINs and PCNs required for pharmacy claims processing early. These BINs and PCNs will be effective starting January 1, 2021.

National Council for Prescription Drug Programs (NCPDP D.0)

Transaction Type Transaction Code BIN PCN
Claim Billing Request B1 022659 6334225
Claim Billing Reversal Request B2 022659 6334225
Claim Rebill B3 022659 6334225
Eligibility Verification Request E1 022659 6334225
Prior Authorization Reversal P2 022659 6334225
Prior Authorization Inquiry P3 022659 6334225
Prior Authorization Request Only P4 022659 6334225
Drug Pricing Inquiry (SB 393 Price Inquiry) B1 022667 393