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1. U.S. Department of Housing & Urban Development (HUD) and Marin County Agreement Will Promote Affordable Housing for Minorities & People with Disabilities U.S. Department of Housing & Urban Development (HUD) and Marin County Agreement Will Promote Affordable Housing for Minorities & People with Disabilities...
2. How to find out if a subscriber must pay a SOC Providers access the Medi-Cal eligibility verification system to determine if a subscriber must pay an SOC.  The message returned by the eligibility verification system includes the SOC dollar amount the subscriber must pay.  The eligibility verification system is accessed through the Point of Service (POS) device, Automated Eligibility Verification System (AEVS), state-approved vendor software and […]...
3. Share of Cost is calculated independently for CMSP and Medi-Cal 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 […]...
4. Welfare and Institutions Code 14018.2 requires providers to make a good faith effort Welfare and Institutions Code 14018.2 requires providers to make a good faith effort to verify the identity of a Medi-Cal recipient by matching the recipient’s name and signature on their Medi-Cal card with a valid California driver’s license, ID card issued by the Department of Motor Vehicles, another type of picture identification card or other […]...
5. 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 […]...
6. 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 […]...
7. 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 […]...
8. 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 […]...
9. Department of Health Care Services (DHCS) will only accept the National Provider Identifier Providers are reminded that t he Department of Health Care Services (DHCS) will only accept the National Provider Identifier (NPI) on all Medi-Cal and Child Health and Disability Prevention (CHDP) program claims. This policy has been in effect since October 1, 2008. To ensure timely payment, pharmacies using the Medi-Cal POS NCPDP Pharmacy Transaction Specifications, […]...
10. Providers may collect SOC payments Providers may collect SOC payments from a subscriber on the date that services are rendered or providers may allow a subscriber to “obligate” payment for rendered services.  Obligating payment means the provider allows the subscriber to pay for the services at a later date or through an installment plan.  Obligated payments must be used by […]...
11. Projecting The Impact Of The Affordable Care Act On California The Affordable Care Act is the most fundamental legislative transformation of the US health care system in forty years. This analysis estimates that the act will provide health insurance for an additional 3.4 million people in California in 2016. This will mean that nearly 96 percent of documented residents of California under age sixty-five will be insured. […]...
12. California – Department of Health Care Services (DHCS) will direct the fiscal intermediary Fiscal Year 2010-11 State Budget Reimbursement Contingency: Since the State of California did not enact the fiscal year 2010-11 budget by June 30, 2010, the Department of Health Care Services (DHCS) will direct the fiscal intermediary, HP Enterprise Services, to implement provisions pursuant to state law, to continue processing and adjudicating claims as outlined below. HP […]...
13. Cancellation and non-renewal of enrollment or subscription, New Dental Choice Plan An enrollment or a subscription may be cancelled or not renewed by Plan for the following reasons:  (a) Failure to pay the Membership Fee if the Subscriber has been duly notified and billed for the Fee and at least 15 days have elapsed since the date of notification. Cancellation of membership will be effective upon […]...