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

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.

Provider Connection

Access network provider tools on Provider Connection website.