Use of Social Security Numbers for Billing Update
Effective for dates of service on or after February 1, 2008, providers may no longer bill Medi-Cal or the Child Health and Disability Prevention (CHDP) program using a recipient’s Social Security Number (SSN). Providers will be required to bill with the Medi-Cal identification number from the recipient’s Benefits Identification Card (BIC) or paper ID card. Claims submitted with a recipient’s SSN for a date of service on or after February 1, 2008 will be denied.
New Denial Message
A new denial message has been developed for the paper Remittance Advice Details (RAD): RAD code 0046: Social Security Number (SSN) not permitted for billing Medi-Cal.
Pharmacy claims submitted with a recipient’s SSN will be denied with Reject Code 07 (Missing or invalid cardholder (recipient) identification number) and Denial Code 0046.
Billing Exceptions
Certain exceptions apply for hospitals, Long Term Care (LTC) facilities, licensed primary care clinics and emergency medical transportation, as indicated by the Welfare and Institutions Code
(W&I Code), Section 14045. The exception criteria will be based primarily on claim type and place of service.
Billing Exception Criteria – Claim Type
The following claim types are excluded from the billing requirements:
Inpatient
LTC
Crossovers
Billing Exception Criteria – Emergency Medical Transportation Services
Emergency medical transportation services are exempt when billed on a medical claim type and with one of the following Place of Service codes:
Ambulance – land (emergency transport only).
Ambulance – air or water (emergency transport only).
Billing Exception Criteria – Physician Services
Physician services rendered in a hospital or LTC facility and hospital outpatient services are exempt when billed on outpatient or medical claim types and with a Place of Service code or facility type code representing one of the following:
Hospital – A hospital licensed pursuant to Health and Safety Code, Chapter 2 (commencing with Section 1250), Division 2.
LTC – A long term health care facility, as defined in Health and Safety Code, Section 1418.
Licensed Primary Care Clinic – A primary care clinic that is licensed pursuant to Health and Safety Code, Section 1204, subdivision (a).
Non-exempt claim types, providers and services include, but are not limited to, the following:
Pharmacy
Optometry
Physician Offices
Medical Groups
Durable Medical Equipment (DME)
CHDP
California Children’s Services (CCS)/Genetically Handicapped Persons Program (GHPP)
Treatment Authorization Requests (TARs) submitted with a recipient’s SSN will continue to be accepted, however, the SSN will be removed before being returned to the provider. Providers are strongly encouraged to use the Medi-Cal identification number from the recipient’s BIC or paper ID card for submitting TARs.
Eligibility Verification Requirements
Eligibility verification should be performed prior to rendering Medi-Cal services. All providers are encouraged to use the Medi-Cal identification number from the recipient’s BIC or paper ID card when verifying eligibility instead of using the recipient’s SSN. If a recipient is unknown to a provider, the provider must make a “good faith effort” to verify the recipient’s identification before rendering services. It is the provider’s responsibility to verify the person’s eligibility and that the person is the individual to whom the card is issued.
In an emergency or if a recipient does not bring a BIC to an appointment, providers may access the Medi-Cal Eligibility Verification System (EVS) and use the recipient’s SSN (with the recipient's approval) to verify eligibility. If the recipient cannot provide a BIC ID number or SSN, the recipient should be instructed to contact their county welfare office. Providers are asked to remind recipients that they need to take their BIC with them to the doctor, dentist, pharmacy, hospital or any other health care provider. Providers are encouraged to print copies of the Always Take Your BIC With You notice and share them with Medi-Cal patients or the patients’ family members, caretaker relatives or authorized representatives. The notice is available in multiple languages on the Medi-Cal Web site (www.medi-cal.ca.gov). From the home page, click “FAQs” then click “Recipient Eligibility Verification.”