How to Find Out If a Subscriber Must Pay a SOC
Monday, Jun. 24th 2024 10:00 AM
When subscribers enroll in Medi-Cal, they may be required to pay a Share of Cost (SOC). Providers can determine if a subscriber needs to spend a SOC by accessing the Medi-Cal eligibility verification system. This system provides the SOC dollar amount that a subscriber must pay. Providers can access the eligibility verification system through the Automated Eligibility Verification System (AEVS), state-approved vendor software, or the Medi-Cal provider website at www.medi-cal.ca.gov.
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- 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 […]...
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- 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 […]...
- 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 […]...
- 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 […]...
- 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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- Reversing Share of Cost Transaction To reverse SOC transactions, providers enter the same information as for a clearance but specify that the entry is a reversal transaction. After the SOC file is updated, providers receive confirmation that the reversal is completed. Once a subscriber has been certified as having met the Share of Cost, reversal transactions can no longer be […]...
Posted on Monday, Jun. 24th 2024 10:00 AM | by Share of Cost | in Share of Cost | Comments Off on How to Find Out If a Subscriber Must Pay a SOC