G. REQUEST FOR REPLACEMENT MEDI-CAL CARDS   

 

Original BIC Not Received by Beneficiary or Incorrect

 

          When the original Medi-Cal BIC card was not received by the beneficiary, the Human Services Specialist (HSS) will:

 

 

 

Step

Action

1

Check MEDS to see if the record is correct and if a card was issued

2

If the MEDS record is incorrect, the HSS must correct it and issue an initial card.

3

If MEDS shows a BIC has been issued, but has been lost, stolen or damaged or the information on the card is incorrect (SSN, DOB, or name), the HSS must provide a replacement :

4

Replacement BIC cards can be processed in CalWIN through:

 

·  Benefit Issuance and Recovery

·  Benefits Issuance (subsystem)

·  Maintain Card Requests

 

Returned Medi-Cal Card

Medi-Cal Benefits Issuance Cards (BICs) that cannot be delivered by the post office will be returned to the CDHS and destroyed or reissued.  The CDHS will report returned BICs to the HSS via MEDS alerts.

 

For BICs that are mailed to an FRC/P.O. Box (e.g. homeless beneficiary), Family Resource Centers (FRCs) will follow their current procedures.  BICs held in the FRC must be kept in a secured location (e.g. FRC safe) and:

 

·        Re-mail the Medi-Cal card to the beneficiary if an address is available.  Document in the case narrative the date and action taken; or

 

·        Cancel the Medi-Cal card(s) using the procedures below, when no address is available.  

 

 

Medi-Cal Card Cancellation

 

When the Medi-Cal card is returned to the HSS and must be cancelled, the HSS will:

 

 

Step

Action

1

Complete form 14-3 DSS indicating that all Medi-Cal cards attached are to be cancelled

2

Attach the Medi-Cal cards to form 14-3 DSS and route to the designated FRC clerk

3

Document the disposition of the Medi-Cal card in the case narrative

4

Document the disposition of the Medi-Cal card in the case narrative

 

Letter of

Authorization

(LOA)

 

HSS’s cannot issue an original numbered Eligibility Letter of Authorization (LOA) MC 180 as proof of eligibility more than one year after the date of service unless one of the following conditions are met:

 

·           A court action requires the letter of authorization;

 

·           An adopted State Hearing Decision or other administrative hearing decision requires a re-determination of eligibility which results in a beneficiary’s entitlement to Medi-Cal;

 

·           An adopted State Hearing Decision states that due to a county department or a CDHS administrative error, a BIC was not received by the beneficiary or eligibility on MEDS was not established;

 

·           CDHS requests the Letter of Authorization;

 

·           The county department has determined that an administrative error has occurred.   

 

 

Definition of

Admin Error

 

An administrative error is defined as an erroneous action, or required action not taken, which resulted in the failure of the county or state to provide a BIC along with documenting eligibility on MEDS within one year of the date of service when the eligibility determination has been conducted according to state regulations, policy and procedures. 

 

 

Admin Errors

Administrative errors include, but are not limited to:

 

·       The applicant/beneficiary provided the county with the necessary information to determine eligibility and the county failed to issue Medi-Cal BIC/benefits.

 

·       The beneficiary requested card issuance and the county failed to take appropriate action.

 

·       The applicant/beneficiary’s case had been erroneously denied or discontinued.

 

·       A computer failure resulted in the delay, non-issuance, or incorrect production of the Medi-Cal BIC.  This includes non-issuance of BICs due to county failure to take corrective action in response to MEDS error alerts.

 

·       The county issues a BIC within one year, but it is coded incorrectly and cannot be used to bill for services rendered.

 

 

Admin Error

Procedures      

 

 

If the county finds that an administrative error has occurred, an original numbered LOA/MC 180 must be completed with the:

 

·       “Administrative error” line checked and a description of the administrative error given;

 

·       Appropriate case information provided (Medi-Cal 14 digit ID number, application date, HSS’s name and phone number); and

 

·       Original signature of the FRC Manager or Assistant FRC Manager.  No photocopies will be accepted. 

 

·       Issue form MC 180 to the beneficiary/provider to authorize billing beyond the one-year limitation period.