California – The California Division of Workers’ Compensation (DWC) has posted an updated pharmaceutical fee schedule data file and calculator. Due to Medi-Cal changes, the usual weekly update file was not available from Oct. 5, 2011 through Nov. 15, 2011. The pharmaceutical fee data file and calculator data posted Sept. 28, 2011 were not updated until the posting of the Nov. 16, 2011 update. The data file and calculator include the updated Medi-Cal fees, but do not include the 10 percent reduction which is applicable to Medi-Cal services but is not applicable to workers’ compensation.
The updated pharmaceutical price data file of Nov. 16, 2011 is posted on the DWC Web site for use in determining maximum workers’ compensation pharmaceutical payments and is utilized in the simple and compound prescription price calculators on the Web site. The updated file allows workers’ compensation payers to make corrected payments for pharmaceutical bills that were paid during the period that updated fees were not available. For the convenience of the public, the DWC has also posted an excel spreadsheet that contains an extract of the data file containing only national drug codes (NDC) that experienced a change after Sept. 28, 2011. Payers and providers may consider whether there are contracts in place that may impact the need to re-process bills and issue corrected payments.
The Nov. 16, 2011 data file and price calculators can be accessed here: CA DWC’s PFS Data File & Price Calculators.
Source: CA DWC