**Reminder**DHCS Encounter Requirement – NDC Required (Update)

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Date: November 5, 2020
To: Health Plan of San Joaquin (HPSJ) All Provider & Facilities
From: Health Plan of San Joaquin
Subject: **Reminder**DHCS Encounter Requirement – NDC Required (Update)
Business: Medi-Cal Managed Care

Health Plan of San Joaquin (HPSJ) sent out a provider alert on August 5, 2019 & September 4, 2020 informing providers of the new DHCS requirement for the National Drug Code (NDC) listed to be submitted with associated Physician Administered Drug (PAD) as part of the encounter data reporting process.

“Effective April 1, 2019 all claim submissions, regardless of the date of service(s) on the claim, should include NDC when billing drug related codes. If claims are submitted without the required NDC or an invalid NDC the claim line will deny, and resubmission of a Corrected Claim will be required [See Corrected Claim Provider Alert(s)].”

As we continue to ensure each claim submission will reconcile with each encounter submission to the California’s Department of Health Care Services (DHCS) –

  • • HPSJ will now be denying the whole claim if the required NDC is not present on the claim and a Corrected Claim submission will be required.
  • Please follow the EDI and/or Paper claim billing instructions on which fields the NDC is required to be billed on allowing the information to be captured and processed correctly.

If you have questions, please contact our Customer Service Department at 209.942.6320.

Medi-Cal Rx: Transition Postponed

The April 1, 2021 transition to Medi-Cal Rx has been delayed by the California Department of Health Care Services (DHCS). Additional information will come from DHCS. Until further notice, HPSJ will continue to offer the pharmacy benefit.

  • Health Plan of San Joaquin pharmacy benefits will be transitioned to and administered by the new agency, Medi-Cal Rx.
  • ALL outpatient pharmacy drugs will be covered by Medi-Cal Rx.
  • The Department of Health Care Services (DHCS) has partnered with Magellan Medicaid Administration, Inc. to provide this benefit and support Medi-Cal Rx.

Secure Medi-Cal Rx Provider Web Portal now live: Register now at https://medi-calrx.dhcs.ca.gov/home

Posted on November 5th, 2020 and last modified on March 12th, 2021.

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