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Instructions for KERN HEALTH SYSTEM models including: Provider Bulletin Periodic Updates, Periodic Updates, Updates
Bulletins | Kern Family Health Care
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DocumentDocumentNovember 30, 2021 Dear Provider: As the transition of the pharmacy benefit from Kern Family Health Care (KFHC) to Medi-Cal Rx (MCRx) approaches, KFHC would like to provide clarification on who should be billed for services provided/rendered. The following services should be billed to Magellan (PBM vendor for MCRx) for dates of service beginning 1/1/2022: Outpatient Medications Condoms Peak Flow Meters Pen Needles Continuous Glucose Monitor/Supplies Vaccines Diaphragms Aerochambers Diabetic Test Strips Enterals Cervical Caps All Syringes Lancets The Payer Sheet information for Magellan is [BIN: 022659, PCN: 6334225, Group: MEDICALRX] In addition to all outpatient pharmacy/medication claims with a date of service prior to 1/1/2022, the following services will remain with KFHC. Please be sure to include the appropriate ICD-10 code for each service billed. After the transition to MCRx, the following services will continue to be billed through KFHC's PBM (SS&C) as they are today. Please continue to bill the services as you do today, through KFHC's PBM. The DHCS/MCRx has confirmed billing through our PBM is acceptable as coding modifications with our PBM have been made to be compliant with billing requirements post transition. Incontinence Supplies Thermometers Nebulizers & Supplies T.E.D. Hose Ostomy Supplies Hand Sanitizer Tablet Cutter Crutches/canes Blood Pressure Machines Braces (wrist/ankle/back/neck) Please keep in mind, the billing is based on the date the service was rendered. For example, if you receive a retro enrollment and you need to bill for a service rendered prior to 1/1/2022, please bill the service to KHS. If the date of service is after 1/1/2022, please follow as outlined above. We know this is a big endeavor. More information regarding the MCRx program can be found at the MCRx website, https://medi-calrx.dhcs.ca.gov/home/ . KHS has posted valuable information received from the DHCS on the KHS website regarding the transition. Please visit www.kernfamilyhealthcare.com . We appreciate your cooperation as we work together through this transition. We want to thank you again for the valuable service you provide to our members. If you have any questions, please contact your Provider Relations Representative. Sincerely, Bruce Wearda, R.Ph. Director of Pharmacy