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Coding Corner: How to report a consult service when your payor doesn’t accept consult codes

August 17, 2021


The California Department of Health Care Services (DHCS) recently announced a January 1, 2022, implementation date for the Medi-Cal Rx program. Earlier this year, DHCS delayed the planned go-live date of April 1, 2021, to give the agency time to review new conflict avoidance protocols submitted by Magellan Health, Inc., the project’s contracted vendor. On July 27, 2021, DHCS completed its review of Magellan’s Conflict Avoidance Plan (CAP) and announced the new implementation date.

Medi-Cal Rx is an initiative aimed at improving health care delivery by standardizing the Medi-Cal pharmacy benefit under one delivery system and improving access to pharmacy services with a network that includes a large majority of the state’s pharmacies.

Starting on January 1, 2021, the new Medi-Cal Rx website will be the place to go to access both public and secure Medi-Cal Rx portals. Starting on January 1, 2022, the secure portal will give pharmacy providers, prescribers and their staff access to the Prior Authorization (PA) system; beneficiary drug look-up tool; and web and batch claims submissions.

For more information, see the DHCS Medi-Cal Rx Frequently Asked Questions (FAQs), which was updated on August 12, 2021, and provides additional guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, and other interested parties.

While the California Medical Association (CMA) continues to support the Governor’s efforts to lower the cost of drugs for all Californians and will continue to partner with the administration in broader health care cost-containment efforts, CMA has remained engaged in the proposed rollout, and vocal about its concerns for the potential lapse in care and benefits that would occur from implementing the program at this time while physicians are still dealing with the COVID-19 pandemic.

 

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