CHA News

Reminder: Reinstatement of Medi-Cal Rx Pharmacy Claim Edits Goes Live July 22

This post has been archived and contains information that may be out of date.

As previously announced in CHA News, the California Department of Health Care Services (DHCS) and its Medi-Cal Rx contractor Magellan will reinstate pharmacy claim edits and Reject Code 88 for diagnosis and drug utilization review requirements on July 22.  

The reinstatement of Reject Code 88 is expected to go live in the Medi-Cal Rx system between approximately 6 and 7 a.m. (PT). Therefore, pharmacies may experience a situation where they are able to submit a claim without receiving the reject code early Friday morning, but may receive the reject code later that day on a similar claim. Please refer to the reference guide and appendix for Reject Code 88 provided by DHCS and Magellan for additional information. 

Once Reject Code 88 reinstatement goes live, any hospital pharmacy team experiencing challenges or issues that cannot be resolved through the Medi-Cal Rx customer service center or for those who have difficulty reaching a service representative, please reach out directly to CHA for assistance. 

DHCS and Magellan had originally planned to also reinstate Reject Code 80 on July 22, but announced that has been postponed. At this time, a new date has not been set for reinstatement of Reject Code 80. 

Also, as a reminder, CHA hosts calls with DHCS and Magellan every other Friday, which providea forum for hospital pharmacy teams to get the latest information on Medi-Cal Rx and raise issues directly with the state and its contractor. As DHCS and Magellan continue to roll out their reinstatement of claim denial codes and prior authorization requirements, this forum will be an opportunity to provide direct feedback on the impact of these reinstated policies, which will be valuable in informing the planning and timing of subsequent phases of reinstatements. For those who are not on this meeting series and would like to be, please contact Barbara Roth to be added.