MedicaidAdministrativeHigh impact
07-16-2026 Stay Informed Medi-Cal Rx Updates and Provider Enrollment Reminder IE LA SAC SD
Molina Healthcare·CA·Medicaid
We identified it
Jul 22, 2026
Summary
Molina Healthcare of California is implementing a new enrollment requirement effective soon whereby only enrolled Medi-Cal providers (doctors, nurse practitioners, physician assistants, and pharmacists) can submit prescriptions for reimbursement. Providers must verify their enrollment status immediately and apply through the PAVE portal if not yet enrolled, as unenrolled providers will face claim denials and care disruptions. The bulletin also alerts providers to multiple formulary and coverage updates including Basaglar removal from the contract drug list (effective August 9, 2026), GLP-1 coverage changes, and updated coordination of benefits rules.
Action Required
IMMEDIATE ACTION REQUIRED: (1) Billing team and clinical staff must immediately verify enrollment status of all prescribing providers (doctors, nurse practitioners, physician assistants) and pharmacists via the Enrolled Providers list by searching individual NPIs. (2) For any provider found NOT enrolled, submit Medi-Cal provider application through PAVE portal immediately—applications take 90-180 days to process, so delays will cause future claim denials. Ensure all required documentation is complete and accurate to avoid processing delays. (3) Update internal provider roster and billing system to flag non-enrolled providers to prevent submission of prescriptions that will be denied. (4) Billing team must review all referenced Medi-Cal Rx Bulletins and News updates, specifically: Basaglar removal effective 8/9/2026, Wegovy coverage changes, GLP-1 coverage updates, Medicare coordination of benefits changes (effective 5/29/2026), and ICD-10 diagnosis code requirements on pharmacy claims. (5) Update claim submission procedures to ensure ICD-10 diagnosis codes are included on all pharmacy claims per the bulletin reminder. CONSEQUENCES: Unenrolled providers' prescription claims will be denied by Medi-Cal starting soon, disrupting member access to medications and creating billing denials that will require rework.