Long Term Care – Share of Cost (SOC) Value Codes
| Date: | May 22, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Providers and Facilities |
| From: | HPSJ |
| Type: | Regulatory/Informational |
| Subject: | Long Term Care – Share of Cost (SOC) Value Codes |
| Business: | Medi-Cal Managed Care |
In accordance with guidelines from the Department of Health Care Services (DHCS), providers may collect Share of Cost (SOC) payments from a member on the date that services are rendered, or providers may allow a member to “obligate” payment for rendered services.
When reporting the SOC for HPSJ members, please adhere to the following reporting guidelines:
837i (electronic) Claim Submission
- When submitting 837i (institutional)claim use value code FC in the code column
field that designates to the corresponding “amount” (Boxes 39-41). - Please reach out to your Clearinghouse for additional field requirements. See Below:
- Transactions in the 5010 format, the HI value information segment in loop 2300 of the 005010X223A2 with a qualifier of BE and value code of FC .
UB04 (paper claim) Submission
- When submitting a paper claim use Value code “23” in the code column field that designates to the corresponding “amount” (Boxes 39-41).
- Please resubmit corrected claims, with the appropriate corrected claim identifier, for any erroneously billed or denied claims.
For more information on Share of Cost billing guidelines and obligating payment, please refer to the Medi-Cal Provider Manual at https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/Part1/share.pdf.
If you have any questions or concerns about these changes, or need assistance, please call our Provider Services team at (209) 942-6340. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.