DHCS to Host July 30 Town Hall on Enrollment Requirements for Pharmacy and Medical Billing Claims
What’s happening: The Department of Health Care Services (DHCS) will host a town hall on July 30 at 9:30 a.m. (PT) to explain Ordering, Referring, and Prescribing (ORP) enrollment requirements for claims across both pharmacy (Medi-Cal Rx) and medical (CA-MMIS) billing systems. While event registration is currently full, interested members should join the waitlist — CHA...
Immediate Action Needed for Prescribers: Ensure Enrollment as Medi-Cal FFS Provider
What’s happening: Claims and prior authorizations will not be processed by Medi-Cal Rx if the prescribing health care provider is not enrolled in Medi-Cal fee-for-service (FFS) with a Type 1 National Provider Identifier. Prescribers not yet enrolled should immediately submit their Medi-Cal provider enrollment application via the Provider Application and Validation for Enrollment page.
Reminder: Include ICD-10-CM Diagnosis Codes on Medi-Cal Rx Claims
What’s happening: As a reminder, ICD-10-CM diagnosis codes will be required for Medi-Cal Rx claims starting this fall.
CHA Pushes Back on Commentary Attacking 340B Program
What’s happening: CalMatters has published a CHA counter op-ed on 340B that reinforces the program’s importance for patients and safety-net providers.
Medi-Cal Rx Claims to Require ICD-10-CM Diagnosis Codes Beginning This Fall
What’s happening: Starting this fall, ICD-10-CM diagnosis code(s) will be required for Medi-Cal Rx claims. This change is being made to better implement appropriate utilization management controls, including prior authorization.
House Letter Urges Appropriators to Block Funding for 340B Rebate Model
What’s happening: U.S. Rep. Doris Matsui led a bipartisan letter requesting that the fiscal year 2027 appropriations bill include language barring the use of funds for implementation of any 340B Rebate Model, including the previously proposed pilot program.
Affordability, Drug Pricing in Focus at Key AHA Meeting
Discussions at this week’s American Hospital Association Regional Policy Board 9 meeting will delve into several timely and weighty issues for hospitals in California and nationwide.
New CHA Infographic Available on 340B Drug Pricing Program
What’s happening: CHA's new infographic illustrates how the 340B program works, highlights its benefits to patients and communities in reducing drug costs and expanding access to care, details who is eligible to participate, and sets the record straight on program oversight and compliance.
HRSA Issues RFI on New 340B Rebate Model Pilot Program, Members Encouraged to Comment by April 20
What’s happening: The Health Resources and Services Administration (HRSA) has issued a request for information (RFI) on whether to implement a new 340B rebate model pilot program and how it might be designed. Comments were originally due by March 19, but HRSA is extending the deadline to April 20.
Action Needed for Prescribers: Ensure Enrollment as Medi-Cal FFS Provider
What’s happening: Beginning on June 26, claims and prior authorizations will not be processed by Medi-Cal Rx if the prescribing health care provider is not enrolled in Medi-Cal fee-for-service (FFS) with a Type 1 National Provider Identifier (NPI).