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.