Statements in Every Newsletter
Whole Child Model for CCS-Eligible Members
Partnership HealthPlan of California’s Whole Child Model (WCM) program provides diagnostic, treatment and case management services for individuals under age 21 who have been diagnosed with a condition eligible for California Children’s Services (CCS). To learn more,
click here.
Eligibility Reminder
Don't forget to check eligibility and primary care provider (PCP) assignments.
It is not uncommon for Partnership members to lose Medi-Cal eligibility or change PCPs. To ensure that providers get reimbursed as appropriate for services provided, Partnership would like to remind provider offices to always check eligibility and PCP assignment prior to providing the service. This can be done by using Partnership's
online eligibility system or by calling our Integrated Voice Response (IVR) system at (800) 557-5471.
Notice about Billing Medi-Cal Members
Per the Department of Health Care Services (DHCS), providers are prohibited from billing or seeking reimbursement from Medi-Cal members which includes but is not limited to; co-payments, deductibles, and/or fees for missed appointments.
Pharmacy
The Partnership Medical Drug List (MDL) Navigator can be found at
https://client.formularynavigator.com/Search.aspx?siteCode=4983900106
For the most current P&T Drug Benefit updates and changes, please see Partnership's
Drug Benefit Updates webpage. Updates from P&T are posted quarterly.
The Partnership
Covered Drug List webpage contains links to the following drug coverage information:
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Quarterly P&T changes for the Partnership medical drug benefit (drugs injected or otherwise given to a member in a doctor's office, clinic, or outpatient hospital).
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The list of Medi-Cal covered medical drugs
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The State Medi-Cal RX covered drug list
Pre-authorization information for both Partnership medical drug request and Medi-Cal RX (pharmacy drugs) can be found
here.
If you would like a copy of the Utilization Management criteria utilized for Partnership's medical drug benefit, please contact Partnership at (800) 863-4155.
Provider Manual
To view Partnership's Medi-Cal Provider Manual including all policies, procedures, and guidelines, click here.
Utilization Management Criteria
Partnership's Utilization Management (UM) criteria
and policies are available by accessing the Partnership Medi-Cal Provider Manual. To view the Provider Manual,
click here.
UM criteria is located in the Health Services category (section 5) within the Provider Manual,
click here to view.
Staff are available to assist you with UM related questions during business hours, 8 a.m. - 5 p.m., Monday through Friday. Calls received after business hours will be returned the next business day.
