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How Pharmacists Register with Medi-Cal to Perform MTM Services (California)

Updated

Overview

To perform Medication Therapy Management (MTM) services under Medi-Cal, both the pharmacist (individual provider) and the pharmacy (organization) must complete specific enrollment and approval steps.

This includes:

  1. Medi-Cal Pharmacy provider enrollment via PAVE
  2. ORP (Ordering/Referring/Prescribing) enrollment for the pharmacist
  3. MTM Supplemental Application (DHCS 6502) approval
  4. Execution of a supplemental services agreement
  5. Adherence to the MTM program requirements outlined by DHCS

Step 1: Confirm Pharmacy Enrollment in Medi-Cal

The pharmacy must be enrolled as a Medi-Cal provider organization.

Requirements

  • Active Medi-Cal enrollment through PAVE
  • Valid organizational (Type 2) NPI

Start here:

During steps 1 and 2 it’s necessary to affiliate the ORP pharmacist Medi-Cal ID with the pharmacy Medi-Cal ID.

 

Step 2: Enroll the Pharmacist as a Medi-Cal Provider (ORP Enrollment)

What is ORP Enrollment?

ORP (Ordering, Referring, Prescribing) enrollment is required for individual providers who are listed on Medi-Cal claims, including pharmacists performing MTM services.

For MTM:

  • The pharmacist is considered the rendering provider
  • Therefore, the pharmacist must be individually enrolled in Medi-Cal

If your pharmacy is already set up as a Medi-Cal Provider, you can go back into your PAVE account and select to enroll pharmacists as ORP providers. This process is much less time consuming and you can complete your enrollment fairly quickly. In order to enroll as an ORP provider, you must have a type-1 National Provider Identification (NPI). If you don’t have this type of NPI, please visit the National Plan and Provider Enumeration System page to sign up for one. 

How to Enroll

Start here:

Slide show instructions:

Important Notes

  • ORP enrollment is mandatory for pharmacists performing MTM
  • Claims may be denied if the pharmacist is not enrolled
  • Enrollment approval can take up to 6 months

 

Step 3: Submit MTM Supplemental Application (DHCS 6502)

Pharmacies must apply separately to participate in the MTM program.

MTM Program Page & Application
https://www.dhcs.ca.gov/provgovpart/pharmacy/Pages/MTM-Services.aspx

What’s Required

  • Completion of the DHCS 6502 (MTM Supplemental Application)
  • Approval from DHCS
  • Execution of a supplemental services agreement

Important

Standard Medi-Cal enrollment alone does not authorize MTM services—this step is required.

 

Step 4: Review MTM Program Requirements

All participating pharmacists and pharmacies should review the official MTM service manual:

👉 MTM Provider Manual
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/4671E3CF-62A5-4BB9-8040-069C92A2B4E0/mtmserv.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO

Key Areas to Understand

  • Eligible patient populations
  • Covered MTM service types
  • Required documentation elements
  • Program rules and compliance expectations

Step 5: Operational Readiness

Before performing MTM services, confirm:

Pharmacist

     ✔ Enrolled in Medi-Cal as an ORP provider

     ✔ Holds active California pharmacist license

     ✔ Has a valid Type 1 NPI

Pharmacy

     ✔ Enrolled in Medi-Cal

     ✔ MTM Supplemental Application approved

     ✔ Supplemental agreement executed

Team Readiness

     ✔ Staff trained on MTM program requirements

     ✔ Staff trained on documentation workflows in WFS

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