Update: New Billing Requirements Prohibit Social Security Numbers

The new billing requirements that prohibit most providers from billing Medi-Cal using a recipient's Social Security Number (SSN) will be implemented after the Department of Health Care Services (DHCS) has completed its provider and recipient outreach.

All providers, including those exempted by law from the billing requirements, are required to make a good faith effort to obtain the recipient’s Benefits Identification Card (BIC) information for billing and to provide that information to other providers, such as pharmacies and labs, which may not have direct contact with the recipient. A good faith effort means that the provider attempts to obtain the BIC information from the recipient at the time the service is provided and makes a subsequent attempt to obtain the BIC or other appropriate documentation from the recipient.

Recipient Outreach
A notice is being mailed to all recipients reminding them of the importance of always taking their BIC with them to the doctor, pharmacy, hospital or any other health care provider. The notice explains to recipients that they can call the county social services office to get their BIC number and that they may not be able to see their doctor or receive their prescription drugs right away without their BIC because providers need the BIC information in order to bill Medi-Cal.

The notice to Medi-Cal recipients: Always Take Your BIC With You! (PDF)

Providers are encouraged to make photocopies of this notice and share it with their Medi-Cal patients or the patients’ family members, caretakers or authorized representatives.

Use of Social Security Numbers
DHCS recognizes the importance of protecting the identity and the health information of recipients and strongly encourages all providers to avoid using a recipient’s SSN whenever possible. This includes avoiding the use of the SSN for the purposes of eligibility verification, submission of Treatment Authorization Requests (TARs) and administrative billing.

For more information about BICs, please refer to the Eligibility: Recipient Identification Cards section in the Part 1 — Medi-Cal Program and Eligibility Provider Manual.

Please see future Medi-Cal Updates for more information.

Note:

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