Medi-Cal Identification Cards

In January 1994, California began issuing permanent plastic Benefits Identification Cards (BIC). The BIC implementation began in Santa Clara County in March 1994. A temporary Paper Card is issued in immediate need situations at Social Services District Offices.

Note: If there are extenuating circumstances, the temporary paper card can be scanned and sent via secure email to the client. The email address must belong to the client and the email must be encrypted.

The BIC and the Paper Card are for access to the California Eligibility Verification and Claim Management System (CA-EV/CMS) and identification purposes only; The BIC/Paper Card does not guarantee Medi-Cal (MC) eligibility.

The BIC and/or temporary Paper Card:

• Allow Online access for providers to verify client eligibility. Providers are given an “Eligibility Verification Claim Number” (EVC), by Electronic Data Systems (EDS) Online. This guarantees provider payment for services.
• Allow the provider to record Online Share of Cost (SOC) obligations for SOC MC cases.
• Provide Online tracking of MEDI Services (specific treatments/services limited to 2 visits per month).
• Provide Online claim billing capabilities for pharmacies.

The Benefits Identification Card

The Benefits Identification Card (BIC) is a permanent plastic card that is tied to the client’s Medi-Cal Eligibility Data System (MEDS) record. The BIC is issued by Electronic Data Systems (EDS) to:

• All MC clients, including Public Assistance (PA) and Other PA clients (i.e. CalWORKs, Foster Care, AAP, Kin-GAP, SSI/SSP).
• Ineligible Members (Aid Code IE) whose medical expenses can be applied to family members in the same MFBU with a SOC.
• Responsible Relatives (Aid Code RR) whose medical expenses can be applied to family members in the same MFBU with a SOC.

In this chapter, the above individuals are referred to as BIC clients.

The Paper Identification Card

The temporary Paper Identification Card is issued Online by the Customer Services Technician (CST) in County Social Services District Offices to:

• Minor Consent clients, and
• Clients with an Immediate Need.

In this chapter, the above individuals are referred to as Paper Card clients.

California Eligibility Verification System and Claim Management System (CA-EV/CMS)

The California Eligibility Verification System and Claim Management System (CA-EV/CMS) is a statewide MC eligibility verification system. The BIC/Paper Card allows the provider to access the CA-EV/CMS system. The health care provider must verify clients’ eligibility for the month(s) of service. In order to access the CA-EV/CMS, the provider must have the following information from the BIC/Paper Card:

• 14-digit identification number
• Client’s Date of Birth, and
• Card Issue Date.

The CA-EV/CMS provides Online eligibility messages which include the following information:

• Client’s ID
• BIC Issue Date
• Date of Service
• County Code
• MC Aid Code(s)
• Other Health Coverage
• Share-of-Cost, if applicable
• MEDI Services
• Restriction messages
• Eligibility messages to tell providers whether a client is entitled to pregnancy services or other special programs with no SOC (e.g. FPL Programs, TB, and postpartum) and/or SOC with other services.

Medi-Cal Eligibility Verification

There are 4 ways for a provider to verify eligibility.

1. Point of Service (POS) Device

The POS device is similar to the bank/credit card readers in retail stores. It communicates with the POS Network to confirm eligibility. The device is triggered either by swiping the BIC through the card reader or keying in the clients’ information. The POS comes with a printer that provides users with proof of eligibility by printing out the eligibility confirmation from the POS device.

1. Claims and Eligibility Real-Time System (CERTS) Software

CERTS is designed to run on a personal computer (PC) to verify client eligibility, clear SOC liability and reserve MEDI Services. Providers can print out eligibility confirmation using the printer attached to their PC.

1. Automated Eligibility Verification System (AEVS)

The AEVS is an automated system that providers access via a touch-tone telephone or computer to verify eligibility, clear SOC liability and reserve MEDI Services. The provider must use a valid Provider Identification Number (PIN) to access AEVS.

1. Third-Party or Provider Developed Software

The providers can develop their own software capable to interact with the POS network to verify clients’ eligibility.

BIC Use/Authorization Use

Only the person whose name appears on the front of the BIC/Paper Card can use that BIC/Paper Card. The BIC is always sent by EDS to the MC client’s address as shown on MEDS record.

A permanent BIC must not be mailed to a temporary address unless there are extenuating circumstances. In these situations, the Eligibility Worker (EW) must change the address on MEDS to the temporary address (and request a new card if necessary), then change the address back the following day. This procedure should only be used with extreme caution.

The BIC must NOT be mailed to any address other than that of the eligible client, nor given to any person other than the client.

Exception: The BIC may be given/mailed to the spouse of an eligible person residing in Long Term Care (LTC), if that spouse is acting as an Authorized Representative; or to the AR when the client is comatose, amnesiac, or incompetent. Similar situations must be approved by an EW supervisor. If this situation occurs, the EW must case comment clearly what actions were taken.

The client will only receive one card. The BIC must be kept by the client even if there is a change in MC eligibility status (i.e. if benefits are active or a Responsible Relative becomes eligible for MC). The client will use the same BIC even if he/she moves to another county or to a different case.

Authorization for use

The BIC and CA-EV/CMS will:

• Serve as authorization for payment of claims for the cost of covered services which meet all the following conditions:

1. Incurred during a month the client is eligible for MC, and
2. Not paid or obligated by the client to meet the SOC requirement,
3. Not covered by Other Health Coverage (OHC)/Prepaid Health Plan (PHP)/Managed Care when the client is a member, and
4. Not payable by a Third Party, and
5. Not prohibited due to limited service status.

• Be issued under the SSI/SSP program for children who receive both SSI/SSP and an AFDC/FC supplemental payment.
• Serve as authorization for payment of covered services received in or outside California.
• Identify clients enrolled with a MC Managed Care plan for benefit purposes. This is important when the client needs emergency treatment while outside of the Managed Care area. The client will also receive a plan identification card from their own Managed Care plan, unless the client is fee-for-service and does not have a Managed Care plan.

Note: Services provided to a newborn child in the month of birth and the following month can be billed to the mother’s MC card if the mother remains eligible for MC. A separate BIC must be issued for the infant by the third month as services must then be billed separately for each client.