Verifying and Clearing Share-of-Cost
- Physicians (does not apply to Cal MediConnect)
- Participating Physician Groups (PPG)
Participating providers must access the Medi-Cal eligibility verification system to determine whether a Health Net member must pay a share-of-cost (SOC). Providers may access the eligibility verification system through the Point of Service device, Affiliate Computer Services (ACS) by telephone or under Transactions on the Medi-Cal website at www.medi-cal.ca.gov. The eligibility inquiry message includes SOC dollar amount and any remaining SOC, if applicable. Members with unmet SOC are enrolled with Health Net in a pended status and the eligibility verification system will indicate Potential Health Net Member.
Providers may collect SOC payments from members on the date of service, or allow them to pay at a later date or through an installment plan. SOC installment plans are between the provider and the member. Health Net does not reimburse providers for SOC payments not paid by the member.
Providers must perform an SOC transaction to clear SOC immediately on receiving payment or accepting obligation from the member for services rendered. Clearing SOC means that the Medi-Cal eligibility verification system shows the member has paid or obligated for entire SOC amount owed. To clear SOC, providers must access the Medi-Cal eligibility verification system and enter the following:
- Provider number
- Provider identification number (PIN)
- Member identification number
- Beneficiary identification card (BIC) issue date
- Billing code and service charge
The SOC information is updated and a response is displayed on the screen or delivered over the telephone. Providers must continue to clear SOC until it is completely cleared. Once SOC is met and the eligibility verification system is updated, members' status will change to Active and eligibility is retroactive to the first of the month.