Pharmacist professional services overview
California law recognizes pharmacists as healthcare providers and requires payment for eligible professional services performed by a pharmacist.
To be eligible for reimbursement, services must be rendered by a pharmacist enrolled with Medi-Cal as an ordering, referring, and prescribing (ORP) provider. Services must also be billed by a Medi-Cal enrolled pharmacy. For more information, refer to the Medi-Cal website.
Blue Shield developed a reference guide to further describe payment for these services.
General guidance documents for pharmacists
Download a quick reference guide (PDF, 1.7 MB), which includes frequently asked questions and other helpful resources.
Claims resources on Provider Connection
- Submitting Claims
- Enrolling in EDI
- Electronic Claims Submission via Electronic Data Interchange (EDI)
- Contact Us
External website resources
- California Pharmacists Association (CPhA)
- California Right Meds Collaborative (CRMC)
- Board of Pharmacy (BOP)
BOP (resources, e.g., clinical practice protocols, sample collaborative practice agreements, etc.) - Department of Health Care Services
California Department of Health Care Services (DHCS) Pharmacy Manual
EDI companion guides
Access our companion guides for trading partners who exchange electronic transactions directly with us.
Sign up for electronic remittance advice and electronic payments
Find the information and forms you need to enroll in ERA and EFT.
National Drug Code requirements for reporting physician administered drugs
Learn about Blue Shield Promise code submission requirements for submitting claims and encounters when reporting physician administered drugs for Medi-Cal and Cal MediConnect members.
Provider dispute resolution policy and procedures
Communicate your questions and concerns to Blue Shield Promise and learn how to appeal or dispute a claim payment.