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1. 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 […]...
2. 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 […]...
3. 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 […]...
4. 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 […]...
5. County Welfare Department Generally Determines SOC Amount Generally, a subscriber’s SOC is determined by the county welfare department and is based on the amount of income a subscriber receives in excess of “maintenance need” levels.  Medi-Cal rules require that subscribers pay income in excess of their “maintenance need” level toward their own medical bills before Medi-Cal begins to pay....
6. 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 […]...
7. 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 […]...
8. 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 […]...
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. Share of Cost Dental Plans, California Dental Network Share of Cost Dental Plans, California Dental Network...
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. Suspension of Entities Submitting Claims for Suspended Providers The July Update is a list of providers who have been added to or removed from the Medi-Cal Suspended and Ineligible Provider List (S&I List) for the month of July. New providers have been added in bold and reinstated providers were removed from the following lists: susp A, susp C, susp E, susp G, susp […]...
13. Where can I find low-cost dental care? Where can I find low-cost dental care? ...