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21-796 Submit Social Determinants of Health Data on Your Claims or Encounters

Date: 11/05/21

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

For Medi-Cal, this information applies to Fresno, Kings, and Madera counties.

Identify member health, social and risk needs to ensure members receive specific services and programs that they require

Capturing social determinants of health (SDOH) data is a critical step in evaluating population health. This is done by reviewing member traits, health, social and risk needs. The emphasis is to improve health equity and identify health disparities and their root causes. This data will also aid in planning and coordinating care as well as providing personalized care to your patients.

How to submit SDOH data

Refer to the 18 Department of Health Care Services (DHCS) priority SDOH codes on page 2 when documenting SDOH as they relate to your patient. Submit these on claims or encounters. The codes are based on the ICD-10-CM.

Be part of the CalAIM’s Population Health Management initiative

Your support in providing SDOH data is vital to the success of the California Advancing and Innovating Medi-Cal (CalAIM) Population Health Management (PHM) initiative. CalAIM’s PHM initiative identifies and manages member risk and need through whole-person care approaches while focusing on and addressing SDOH.

DHCS Priority SDOH Codes

Code

Description

Z55.0

Illiteracy and low-level literacy

Z59.0

Homelessness

Z59.1

Inadequate housing (lack of heating/space, unsatisfactory surroundings)

Z59.3

Problems related to living in residential institution

Z59.4

Lack of adequate food and safe drinking water

Z59.7

Insufficient social insurance and welfare support

Z59.8

Other problems related to housing and economic circumstances (foreclosure, isolated dwelling, problems with creditors)

Z60.2

Problems related to living alone

Z60.4

Social exclusion and rejection (physical appearance, illness or behavior)

Z62.819

Personal history of unspecified abuse in childhood

Z63.0

Problems in relationship with spouse or partner

Z63.4

Disappearance and death of family member (assumed death, bereavement)

Z63.5

Disruption of family by separation and divorce (marital estrangement)

Z63.6

Dependent relative needing care at home

Z63.72

Alcoholism and drug addiction in family

Z65.1

Imprisonment and other incarceration

Z65.2

Problems related to release from prison

Z65.8

Other specified problems related to psychosocial circumstances (religious or spiritual problem)

Additional information

If you have questions regarding the information contained in this update, you may contact the Access and Availability Unit via email at CVH-CAP@healthnet.com or CalViva Health at 888-893-1569.



Last Updated: 06/06/2022