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1. 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 […]...
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. 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 […]...
6. 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 […]...
7. 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 […]...
8. Share of Cost Case Summary Your Medi-Cal case has been affected by a lawsuit called Sneede v. Kizer.  This lawsuit limits which family members may use medical expenses that are not billed to Medi-Cal to meet their family’s Share of Cost. If you are a spouse or a parent, you have the choice of listing your medical expenses in any […]...
9. 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 […]...
10. Share of Cost, The Number Of U.S. Adults Treated For Diabetes More Than Doubled Between 1996 And 2007 Approximately 19 million U.S. adults reported receiving treatment for diabetes in 2007, more than double the 9 million who said they received care in 1996, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. AHRQ also found that between 1996 and 2007: — The number of people age 65 […]...
11. Share of Cost Dental Plans, California Dental Network Share of Cost Dental Plans, California Dental Network...
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. Dental Health Services, Share of Cost California Dental Plan Review Dental Health Services, Share of Cost California Dental Plan Review...
14. 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....
15. Similar But Different – Deficits In Number Processing In Children With ADHD And Alcohol Exposure New research shows that ADHD and alcohol exposure in children while similar have different causes On the surface, children with fetal alcohol exposure and attention deficit hyperactivity disorder (ADHD) appear to be similar with respect to poor academic performance But a new study exploring number processing shows that each disorder appears to affect different areas […]...