Medi-Cal Rx Payer Sheet Now Available

Update Published December 9, 2020

Given the ongoing challenges and constantly evolving health care landscape associated with the unprecedented COVID-19 public health emergency (PHE), the Department of Health Care Services (DHCS), in partnership and collaboration with Magellan Medicaid Administration, Inc. (Magellan), has decided to lengthen the time for the full implementation of the transition to Medi-Cal Rx by three (3) months. DHCS and Magellan will continue to dedicate their combined efforts and rigorous preparations towards Assumption of Operations (AOO) for Medi-Cal Rx on April 1, 2021. In the interim, all current processes and protocols, both effectuated by DHCS and our Medi-Cal managed care plans (MCPs), respectively, will remain unchanged and in place until Medi-Cal Rx launches. More information on this extension can be found in the article titled “Medi-Cal Lengthens Transition Time to Full Implementation – Go-Live on April 1, 2021” that published on November 16, 2020.

Original Published November 6, 2020

Effective January 1, 2021, Magellan Medicaid Administration, Inc. (Magellan) will be the new Medi-Cal Rx vendor. 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) will transition to Magellan.

Medi-Cal Rx Payer Sheet

In anticipation of this transition, the Payer Sheet is now available on the Medi-Cal Rx Web Portal in the Forms and Information Section. The payer sheet includes the claim submission fields and requirements to submit Medi-Cal pharmacy claims on or after January 1, 2021. The new Payer Sheet also includes updated contact information. Pharmacy providers and their billing agents can use this information to begin making changes to their processes and technical solutions.