Provider Alerts

APL 24-010

APL 24-011

• When a member has a SOC, the facility must subtract the SOC payment collected or obligated payment from the claim amount before submitting the claim to Health Plan to pay the balance.
• Members can elect to use the SOC funds to pay for necessary, non-covered medical or remedial care services or items that are prescribed by a physician and part of the member’s plan of care. The physician’s prescriptions for SOC expenditures must be maintained in the member’s medical record.
• If a member spends part of their SOC, the facility must subtract those amounts from a member’s SOC and adjust the amount on the claim before submitting the claim to Health Plan to pay the balance.
• Facilities that collect SOC payments or obligated payments are responsible for certifying SOC payments in the Medi-Cal eligibility verification system to show the member has paid or obligated payment for the monthly SOC amount owed.

• Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) Homes can be deemed credentialed via attestation if the ICF/DD Homes’ state regulatory processes are current.
• ICF/DD Homes must submit an ICF/DD Attestation confirming that the following credentialing requirements are satisfied:
  • Completion of Health Plan’s specific Provider Training within the last two (2) years
  • Facility Site Audit from a State Agency
  • No change in 5% Ownership Disclosure since the last submission to Health Plan
  • Possession of an active CDPH License and CMS Certification
  • In good standing as a Regional Center Vendor

• Re-credentialing is to occur every two years through re-submission of an ICF/DD Attestation.
• If there is any change to the requirements attested to, ICF/DD Homes must report the change to Health Plan along with any required documentation, within 90 days of when the change occurred.
• For initial credentialing, ICF/DD Homes must submit the following in addition to the ICF/DD Attestation:
  • W-9 Request for Taxpayer Identification Number and Certification
  • Health Plan’s Ancillary Facility Network Provider Application
  • Certificates of Insurance (Professional and General Liability)
  • City or County Business License (excludes ICF/DD-H and -N homes with six or fewer residents)
  • 5% Ownership Disclosure