KERN HEALTH SYSTEM Provider Bulletin Periodic Updates Instructions
- June 12, 2024
- KERN HEALTH SYSTEM
Table of Contents
KERN HEALTH SYSTEM Provider Bulletin Periodic Updates
Product Information
The product mentioned in the user manual is a pharmacy benefit transition from Kern Family Health Care (KFHC) to Medi-Cal Rx (MCRx). The manual provides clarification on who should be billed for services provided/rendered during the transition.
- Product Name: Pharmacy Benefit Transition from KFHC to MCRx
- Provider: Kern Family Health Care
- PBM Vendor for MCRx: Magellan
- Payer Sheet Information for Magellan: BIN – 022659, PCN – 6334225, Group – MEDICALRX
- Transition Date: January 1, 2022
Product Usage Instructions
Below are the instructions for billing services provided/rendered during the transition:
- Outpatient Medications
- Condoms
- Peak Flow Meters
- Pen Needles
- Continuous Glucose Monitor/Supplies
- Vaccines
- Diaphragms
- Aerochambers
- Diabetic Test Strips
- Enterals
- Cervical Caps
- All Syringes
- Lancets
- 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 note that the billing is based on the date the service was rendered. If
you receive a retro enrollment and need to bill for a service rendered prior
to January 1, 2022, please bill the service to KHS. If the date of service is
on or after January 1, 2022, follow the instructions provided above. For more
information about the MCRx program, visit the MCRx website at https://medi-
calrx.dhcs.ca.gov/home/. Kern Family Health Care (KHS) has also posted
valuable information received from DHCS on their website. Visit
www.kernfamilyhealthcare.com.
for more details. If you have any questions, please contact your Provider
Relations Representative. Sincerely, Bruce Wearda, R.Ph. Director of Pharmacy
Dear Provider: As the transition of 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
- Vaccines
- Enterals
- Condoms
- Diaphragm
- Cervical Caps
- Peak Flow Meters
- Aerochambers
- All Syringes
- Pen Needles
- Diabetic Test Strips
- Lancets
- Continuous Glucose Monitor/Supplies
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