MedicaidAdministrativeHigh impact
[California] Medi-Cal Managed Care enrollment requirements
Anthem BCBS·CA·Network
Effective date
Sep 1, 2026
We identified it
Jul 29, 2026
Summary
Beginning fall 2026, all ordering, referring, and prescribing providers in California must be enrolled with Medi-Cal Managed Care to have eligible prescriptions, referrals, orders, and related claims reimbursed. Providers not directly billing Medi-Cal Managed Care must complete free ORP-only (Ordering/Referring/Prescribing) enrollment through the PAVE website; approval may take 60-180 days depending on provider type.
Action Required
By September 1, 2026: (1) Billing team must verify enrollment status of all ordering, referring, and prescribing providers using their individual Type 1 NPI on the DHCS enrolled provider list. (2) For any providers not enrolled, submit ORP-only enrollment applications through the PAVE website using individual Type 1 NPIs and electronic signatures immediately to allow time for approval (up to 90 days for physicians, 180 days for other provider types). (3) Update internal provider credentialing records to track enrollment status. (4) Brief all providers who order, refer, or prescribe for Medi-Cal Managed Care members on the new requirement. Failure to complete enrollment will result in claim denials and prescription ineligibility for Medi-Cal Managed Care members.