20-950 What You Need to Know: Medi-Cal Pharmacy Benefit Transition to Medi-Cal Rx
Date: 12/21/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Get ready with online training available now
Be prepared for the upcoming transition of Medi-Cal pharmacy benefits to the new program called Medi-Cal Rx. To learn more and access resources, visit the Health Net provider portal.
What is Medi-Cal Rx and when does it go into effect?
Medi-Cal Rx is the transition of all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries to the new Medi-Cal Rx vendor, Magellan. Medi-Cal Rx goes into effect on April 1, 2021. This date replaces the former effective date of January 1, 2021, communicated in provider update 20-802, Alert: Medi-Cal Managed Care Pharmacy Benefit Carve-Out and Transition to Medi-Cal Rx.
The transition will include all pharmacy services billed as a pharmacy claim, including, but not limited to, outpatient drugs (prescription and over the counter), physician administered drugs, enteral nutrition products and medical supplies.1
Medi-Cal Rx is also responsible for pharmacy services such as:
- Prior authorizations (PAs).
- Customer service for pharmacy for beneficiaries and providers.
- Pharmacy network administration.
For more information, refer to the Medi-Cal Rx scope document for covered services after April 1, 2021, on the Department of Health Care Services (DHCS) website.
How does it affect prescribers?
As a prescribing Medi-Cal Provider, registration for the Medi-Cal Rx web portal will be required to access pharmacy services tools for PAs, pharmacy claim submissions and status updates.
Visit the Medi-Cal Rx website for a quick start job aide.
The systems currently used to submit PAs for prescriptions and pharmacy claim submissions will change. As of April 1, 2021, Medi-Cal prescribers will use the secure Medi-Cal Rx Provider Portal at https://medi-calrx.dhcs.ca.gov/provider to perform multiple functions related to the submission of PA requests, including, but not limited to, the following: PA submissions, status inquiries, cancellations and adding additional information or documents to “In Progress” requests. The transition to Medi-Cal Rx will also include an updated Contract Drug List (CDL) that you will need to get familiar with.1
What should I do?
Start by visiting the new Medi-Cal Rx website to review general information about the transition and to access registration and training for the new Medi-Cal Rx web portal. The Medi-Cal Rx website serves as a platform to educate and communicate available resources, information, and changes to interested parties. Educational content and frequently asked questions will be posted and updated regularly. Additionally, a Medi-Cal Rx Subscription Service (MCRxSS) is available so interested parties can sign up and receive regular Medi-Cal Rx updates by email.1 You can sign up for the service on the DHCS Medi-Cal Rx subscription sign-up page.
Next, get familiar with the CDL by visiting FAQs on the Medi-Cal Rx website and clicking the Policy Considerations link on the left side of the screen. The current CDL can be viewed on the Medi-Cal website under Provider Manuals. In the future, the CDL will be available on the Medi-Cal Rx website.1
Register – it’s required
Medi-Cal providers (including, but not limited to, pharmacies and prescribing physicians) will need to register to have access to the secure Medi-Cal Rx Provider Portal in addition to the public Medi-Cal Rx website. To register:
- Go to the Medi-Cal Rx website.
- Click the Secured Portal Access drop-down menu on the upper-right side of the screen and choose the Provider Portal option. The Provider Portal home page opens.
- Click the Register icon on the upper-right side of the screen.
Once the registration process is complete, secure access is available via the Medi-Cal Rx Provider Portal. In the future, the Provider Portal will include the following functionalities: 1
- Beneficiary eligibility lookup
- Web claims submission
- Prior authorization submission and inquiry
- Learning management system
- Secure message center
- Secure chat
Get started: Provider education and training
All Medi-Cal Rx providers, including pharmacies, prescribers and their staff, must complete secure web portal registration to access education and outreach training calendars, training course enrollment and resources.
These materials are located in the Learning Management System, Saba®. All education and outreach events will be posted in a calendar on Saba and providers can enroll in web-based instructor-led or computer-based training. To access Saba, providers must use the User Administration Console registration tool at the Medi-Cal Rx website.2
To view a schedule including dates and times of training, visit the Medical Rx website’s Pharmacy News page and click on Medi-Cal Rx Web Portal Registration & Training Update. Note, some materials on the DHCS website may be in the process of being updated to reflect the new implementation date of April 1, 2021.
Get more help online
For more information, visit the Health Net provider portal or refer to the resources listed below.
Provider Resources
Topic | Go to… |
|---|---|
Medi-Cal Rx overview | DHCS Medi-Cal Rx Homepage |
Medi-Cal Rx Subscription Service | The DHCS Medi-Cal Rx subscription sign-up page. Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal Rx website. |
For general questions related to Medi-Cal Rx, email RxCarveOut@dhcs.ca.gov.
Additional information
Providers are encouraged to access the provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 1-800-675-6110.
Sources
1 Medi-Cal Rx Prescriber Communication
2 Medi-Cal Rx Web Portal Registration & Training Information