DATE: December 13th, 2022
TIME: 3:00pm-4:30pm PT
REGISTRATION CLOSES 12/11/22
NOTE TO ALL REGISTRANTS: After registering for this training you will receive two emails: one immediately upon registration confirming your order, and a second with a link to the Zoom registration page by 11:59 pm PT of the evening you register. If you do not receive the second email with the link by by 11:59 pm PT of the evening you register, please email firstname.lastname@example.org By completing this registration you will have the option to add this training to your calendar.
On January 7, 2019 Governor Newsom issued Executive Order (N-01-19) to create a single-purchaser system of drugs in California. Specifically, the Executive Order directs the Department of Health Care Services (DHCS) to transition all pharmacy services for Medi-Cal managed care (MCO) to Fee for Service (FFS). This is known as the pharmacy transition, or Medi-Cal Rx, and went into implementation on January 1, 2022.
On June 1, 2022, the California Department of Health Care Services (DHCS), in collaboration with Magellan Medicaid Administration, Inc. (MMA), released the Reinstatement Plan (the Plan) for a phased approach to restoring select claim edits and prior authorizations (PAs) by drug class while phasing out the 180-day transition policy. The Plan reflects a methodical, data-driven, and iterative approach to support rapid cycle improvements by incorporating feedback from stakeholders and lessons learned from each phase to ensure alignment with the objective to reduce disruption as well as timely delivery of the pharmacy benefit.
To date, DHCS has reinstated claim edits for Drug Utilization Review (DUR) Reject Code 88 and prior authorizations for 11 standard therapeutic classes for beneficiaries who are starting a new drug therapy. Reinstatement is ongoing, and more phases and waves will be announced.
In light of Reinstatement, Magellan will host a health center focused workshop for CPCA health center members on December 13th @ 3pm. The workshop will be an educational opportunity to learn about how to properly bill Medi-Cal Rx through their claims processes, including for those who are 340B providers. During the training we will also discuss how to submit PAs as well as provide resources to support providers.
- Participants will receive information regarding the following topics:
- Claim Submission via POS, web & batch, and paper
- Claim Appeal processes
- PA Submission via CoverMyMeds, Medi-Cal Rx Provider Portal, P4, fax, and mail
- PA Appeal processes
- 340B considerations
- Medi-Cal Rx resources
The fees for this training have been waived.
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CPCA provides training and education to community health centers for general illustration and instructional purposes. As an anti-racist organization, we are committed to providing educational opportunities that are unbiased and meet the fullest standards for cultural and linguistic competency for both accredited and non-accredited events. To that end, our Association intends to be in full compliance with the intent of AB 241 Implicit Bias in continuing education and AB 1195 Continuing Education: cultural and linguistic competency. Please read through the text of these bills to understand the intent of the legislature, now codified as California Business and Professions Code 2190.1.
Registration is required for all CPCA training and events.You will receive two email communications immediately upon registering. The first is simply a receipt. The second from firstname.lastname@example.org and will contain webinar access information. This email will only be delivered to the individual who is registered for the event and will contain a unique link for a single connection. We recommend you add this event to your calendar using the link contained in your webinar access email. If you do not receive this email, please check your spam/junk folders before contacting email@example.com.
Cancellation Policy: Effective 11/1/21 - No refunds will be available for cancellations that are received within 10 business days before the start date of the event/training. To receive a maximum refund of 50% of the registration price prior to this deadline, all cancellations must be in writing and submitted by emailing firstname.lastname@example.org. Substitutions of registrations in lieu of cancellation is encouraged.
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Disclaimer:The information on this session is intended only to provide a general overview of the topics addressed. This session is not intended to provide legal advice or substitute for the guidance, counsel or advice of legal counsel on any matters particular to a specific primary care clinic. CPCA does not endorse companies or products. Advertising and sponsorship revenue supports our not-for-profit mission.