Medi-Cal Retroactive Recoupments Rescheduled
The Department of Health Care Services (DHCS), which administers the Medi-Cal program, has announced that recoupment for retroactive payments associated with the 10% (AB 97) Medi-Cal providercuts will now begin no sooner than August 28, 2015. DHCS and the state's Fiscal Intermediary, Xerox, had previously announced a start date of August 1, 2015. DHCS states that pharmacies will begin receiving payable notices after August 28, however due to the volume of claims associated with the recoupment, initial notices will be rolled out to providers over approximately 16 weeks. Providers will receive supporting claim detail (in the form of a Remittance Advice Detail (RAD)) informing them of the total amount due and line-by-line adjustments. Receipt of the RAD will then be followed by the five percent reductions to the provider's weekly check-writes. The state implemented the 10% Medi-Cal provider cuts in June 2011, however, for pharmacy providers these cuts did not begin until February 2014. The retroactive recoupment discussed here covers claims submitted in that period between June 2011 and February 2014. The "exempt drug list," which includes drugs that are not subject to the 10% cuts, will apply retroactively as well. DHCS has posted this update to the Pharmacy Benefits Division webpage under "Hot Topics." Additional information related to the AB 97 reductions can be found on the DHCS AB 97 webpage.
Questions specific to the AB 97 EPC process should be directed to the
Telephone Service Center
at
1-800-541-5555
, option 1 (for English), option 1 (for Provider), option 5 (for HAP, Family PACT, CHDP, CCS, GHPP, Crossover, LTC and other general billing inquiries), followed by option 6 (for general billing).
CPhA continues to be engaged in this issue and will provide additional information when it becomes available. |