Share of Cost is calculated independently for CMSP and Medi-Cal
Tuesday, Oct. 25th 2011 6:03 AM
SOC policy also applies to County Medical Services Program (CMSP) providers and subscribers. Share of Cost is calculated independently for CMSP and Medi-Cal, however, the same subscriber income is included in both calculations. Therefore, the same medical expenses may be used to clear SOC for both programs. Providers may apply the same services used to clear a Medi-Cal SOC obligation to clear a CMSP SOC obligation. Two separate transactions are required. Clearing Share of Cost for one program does not automatically clear SOC for the other program.
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Share of Cost is calculated independently for CMSP and Medi-Cal, 5.0 out of 5 based on 2 ratings Related posts:
- Share of Cost Clearance Transaction To clear a subscriber’s SOC, the provider accesses the Medi-Cal eligibility verification system, enters a provider number, Provider Identification Number (PIN), subscriber identification number, BIC issue date, billing code and service charge. The SOC information is updated and a response is displayed on the screen or relayed over the telephone. Several clearance transactions may be […]...
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- Medi-Cal Claims: A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs between […]...
- Share of Cost, Medi-Cal, NICE Consults On Draft Guideline On Food Allergies In Children NICE has opened the consultation on its draft clinical guideline on the diagnosis and assessment of food allergies in children and young people. Its aim is to support GPs and other health professionals in primary care and community settings in recognising the signs and symptoms of food allergy, by giving clear recommendations on taking allergy-focussed […]...
- SOC: What is a Eligibility Verification Confirmation (EVC) number for Share of Cost Once SOC has been certified, an Eligibility Verification Confirmation (EVC) number is displayed in the message returned by the Medi-Cal eligibility verification system. Return of an EVC number does not guarantee that a subscriber qualifies for full-scope Medi-Cal or CMSP benefits. It does, however, indicate that the subscriber qualifies for at least partial services. Providers […]...
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- Long Term Care Share of Cost Providers receiving an eligibility verification message (see following example) that indicates a subscriber has an LTC SOC should not clear the SOC online. Subscribers with aid codes 13, 23, 53 and 63 must have their LTC SOC cleared on the claim. The LTC facility includes the LTC SOC amount for Medi-Cal-covered services on the Payment […]...
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- Medi-Cal Hotlines Medi-Cal Hotlines Border Providers (916) 636-1200 DHCS Medi-Cal Fraud Hotline 1-800-822-6222 Telephone Service Center (TSC) 1-800-541-5555 Provider Telecommunications Network (PTN) 1-800-786-4346 Share on Facebook...
- Certifying Share of Cost Benefits and Coverage Subscribers are not eligible to receive Medi-Cal benefits until their monthly Share of Cost dollar amount has been certified online. Certifying SOC means that the Medi-Cal eligibility verification system shows the subscriber has paid or become obligated for the entire monthly dollar SOC amount owed. Claims submitted for services rendered to a subscriber whose SOC […]...
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