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1. 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 […]...
2. Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare’s cost growth in their […]...
3. Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades In 2009, US health care spending grew 4.0 percent—a historically low rate of annual increase—to $2.5 trillion, or $8,086 per person. Despite the slower growth, the share of the gross domestic product devoted to health spending increased to 17.6 percent in 2009 from 16.6 percent in 2008. The growth rate of health spending continued to outpace the growth of the […]...
4. 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 […]...
5. 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 […]...
6. Oregon Share of Cost, Join Neutrogena’s Wave For Change And Help Raise Up To $200,000 For Disaster Relief, Education And Environmental Charities Oregon Share of Cost, Join Neutrogena’s Wave For Change And Help Raise Up To $200,000 For Disaster Relief, Education And Environmental Charities: Understanding teens’ determination and passion for change, Neutrogena, the #1 dermatologist-recommended skin care brand, is launching Wave for Change, a charitable campaign that makes it easy for teens everywhere to not only give […]...
7. California Dental Plan, New Dental Choice Provider Choices California Dental Plan, New Dental Choice Provider Choices...
8. 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 […]...
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. 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 […]...
11. Share of Cost Rx Discount Drug Card: Free to Consumers Get your FREE prescription drug discount card   You can save from 10% to 85% on the cost of both brand name and generic prescriptions immediately. There are no claim forms to fill out and no limits to the number of times you or your family can use the card. Medicare drug discounts are available only […]...
12. 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 […]...
13. 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 […]...
14. Analyzing Shifts In Economic Risks To Providers In Proposed Payment And Delivery System Reforms [Payment & Delivery] A key consideration in implementing the Patient Protection and Affordable Care Act of 2010 will be changing Medicare payments to providers to slow the growth in costs and spur improvements in health care delivery. In addition to the technical feasibility of new payment models, a crucial issue will be the capacity of the health care […]...
15. How does the Careington discount dental plan work in California? I am not sure how well the plan would work for the Share of Cost Medi-Cal program since the SOC program generally requires dental insurance but the discount plan should work for many others. CareingtonDental.com web site indicates all of the dental service charges are reduced if performed by a participating general dentist....