- Participating Physician Groups (PPG)
The Department of Health Care Services (DHCS) established the Health Care Options (HCO) referral process to provide Medi-Cal beneficiaries with information on the benefits of receiving health care services through managed care plans and to help the beneficiary choose a managed care plan. The HCO enrollment contractor is also responsible for assigning beneficiaries who fail to choose a health plan on the Medi-Cal Choice form.
Beneficiaries who have questions regarding the enrollment process can be referred to the HCO enrollment contractor.
Initial Eligibility or Annual Redetermination
The HCO enrollment contractor sends an enrollment packet to all Medi-Cal beneficiaries who do not make a choice at an HCO enrollment contractor presentation. The enrollment packet contains provider directories, a health plan comparison chart, enrollment instructions, Medi-Cal Choice form, and Medi-Cal Choice booklet.
Medi-Cal Choice Form for Enrollment
The beneficiary must select a health plan in his or her designated county and complete and mail back the Medi-Cal Choice form to the HCO enrollment contractor within 30 days of receiving the Medi-Cal Choice form from the HCO enrollment contractor. If the beneficiary does not select a health plan, the HCO enrollment contractor assigns one based on DHCS criteria.
Health plans and affiliated physicians may not submit Medi-Cal Choice forms on behalf of Medi-Cal beneficiaries. The HCO enrollment contractor mails enrollment forms directly to Medi-Cal beneficiaries.
The HCO enrollment contractor notifies the applicant or beneficiary in writing of the assignment to a Medi-Cal health plan at least 10 business days prior to submitting the documents to the DHCS. If the assignment is not appropriate, or if the beneficiary wishes to enroll in a different Medi-Cal health plan, the beneficiary must contact the HCO enrollment contractor to enroll in another Medi-Cal health plan. If a beneficiary chooses a health plan but neglects to choose a primary care physician (PCP), the health plan automatically assigns a PCP. Refer to the Primary Care Physician Selection and Assignment discussion under the Member Rights and Responsibilities topic for additional information.
Member Information Mailed
A packet containing provider directories, a health plan comparison chart, enrollment instructions, Medi-Cal Choice form, and Medi-Cal Choice booklet is mailed to new members by the state's enrollment contractor.
New Member Files
Health Net receives an enrollment tape from the HCO enrollment contractor and a Medi-Cal Eligibility Data System (MEDS) tape from DHCS. The HCO enrollment contractor data is uploaded into Health Net's computer system to create a new member record, and the MEDS tape is run against the new member record to update eligibility. This process creates a new member file for the purpose of producing identification cards.
Identification Card and Member Material Distribution
Health Net sends new members a welcome letter and packet, which includes the Evidence of Coverage (EOC), provider directory, preventive care services, and other important plan information. The materials are in the language preference indicated by the member. The ID cards and the new member packets are mailed within seven days of the member's effective date of enrollment.
Health Net has adopted the Client Index Numbers (CINs), issued by the Department of Health Care Services (DHCS), as the identification (ID) numbers for all Health Net Medi-Cal managed care members. The CIN is formatted as an alphanumeric code, beginning with eight digits followed by a letter at the end.
In compliance with California law (SB 168 (ch. 720, 2001)), the CIN replaces the member's Social Security number (SSN) as the member ID number on most member-oriented materials and communications, including member ID cards.
Provider-oriented materials, including eligibility reports and other health plan correspondence, include both the member's CIN and SSN for identification purposes. Health Net also continues to use SSNs for internal verification and administrative purposes as allowed by law