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 required to fully certify SOC. In other words, providers must continue to clear SOC until it is completely certified. (Clearing Share of Cost is also referred to as “spending down” the SOC.) Providers must perform an SOC clearance transaction immediately upon receiving payment, or accepting obligation from the subscriber, for the service rendered.
Delays in performing the SOC clearance transaction may prevent the subscriber from receiving other medically needed services. Submit only one SOC clearance transaction for each rendered service used to clear the subscriber’s Share of Cost, even if a payment plan is used to meet the obligation. All medically necessary health services – including medical services, supplies, devices and prescription drugs, whether Medi-Cal covered or not – can be used to meet Share of Cost for Medi-Cal and County Medical Services Program (CMSP) purposes. (Refer to “CMSP: SOC Policy Applies” elsewhere in this section for additional information.)