21-676 Medi-Cal Rx Transition: Use Updated Fax Numbers to Avoid Delays for Pharmacy Prior Authorizations
Date: 11/12/21
The Medi-Cal Rx transition is effective January 1, 2022
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 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 January 1, 2022.
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 January 1, 2022, on the Department of Health Care Services (DHCS) website.
What you should do
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.
- PA 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 from 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 Portal Registration. Note, some materials on the DHCS website may be in the process of being updated to reflect the new implementation date of January 1, 2022.
Request PA in one of the following ways for pharmacy benefit drugs, starting January 1, 2022
- Visit covermymeds website.
- Log in to the provider portal and submit the PA through our secured PA tool.
- Send a completed PA form via fax to 800-869-4325.
- Submit a NCPDP P4 transaction through the pharmacy POS system.
- Send a completed PA form through mail to:
Medi-Cal Rx Customer Service Center
Attn: PA Request
PO Box 730
Sacramento, CA 95741-0730
Office-administered drugs and medical benefit drugs
Office-administered drug requests and medical benefit drug reviews billed on medical claims are not a Medi-Cal Rx benefit. You should continue to submit those to the plan via fax to 833-953-3436.
For additional information, please refer to the Medi-Cal Rx Options for PA Submission Guide on the Medi-Cal Rx website.
Prepare for the transition with a Medi-Cal Rx 101 webinar
The upcoming Medi-Cal Rx 101 webinars review the transition, provider portal information, prior authorizations, the contract drug list and more. Magellan is hosting the webinars.
Sign up today! Use the links in the chart below to join a Medi-Cal Rx 101 webinar at the designated time. All times are Pacific time.
Date | Time | Topic | Webinar link |
|---|---|---|---|
Monday, November 15, 2021 | 10–11 a.m. | Medi-Cal Rx 101 | |
Thursday, November 18, 2021 | 10–11 a.m. | Medi-Cal Rx 101 |
Get more help online
For more information, visit the provider portal or refer to the following resources.
Topic | Go to… |
|---|---|
Medi-Cal Rx overview | Medi-Cal Rx website > Provider Portal |
Medi-Cal Rx Subscription Service | The 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
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.
2 https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30429_08.aspx.