Each contract for fiscal intermediary services shall provide for an automated system for verifying the eligibility of Medi-Cal recipients. The automated eligibility verification system shall provide the health care provider with a unique method of identifying the eligibility of the beneficiary. The provider shall include the eligibility identifier on the claim for payment. Where a recipient’s eligibility has been verified by the automated system and the provider provides a unique identifier on the claim form, the
director may not require any label, card impression, or any other evidence to establish the recipient’s eligibility. The automated system for eligibility verification shall provide for the continuous updating of recipient eligibility determination.
The department shall periodically test the automated system for verifying recipient eligibility for completeness and accuracy, and report the findings of such testing to the Legislature. Unless and until the automated system for verifying recipient eligibility is accurate in at least 97 percent of the cases tested, the director shall provide for the issuance of proof-of-eligibility labels, or identity cards from which an identifying impression may be taken, or other evidence of eligibility to be used as a secondary recipient eligibility verification system. Notwithstanding the inability to provide verification of a recipient’s eligibility through use of the automated system for eligibility verification, presentation of a
claim for service with evidence of recipient eligibility as is provided for by the secondary system shall conclusively establish the recipient’s eligibility.
On-line access shall be available to providers, at their discretion, upon the payment of a reasonable fee. The department shall establish the amount of the fees charged to providers for on-line access, which shall be based upon the costs of providing on-line access to providers.
14000
14000.1
14000.2
14000.03
14000.3
14000.4
14000.05
14000.5
14000.7
14001
14001.1
14001.11
14002
14002.5
14003
14004
14005
14005.1
14005.2
14005.3
14005.4
14005.5
14005.6
14005.7
14005.8
14005.9
14005.10
14005.11
14005.12
14005.13
14005.14
14005.15
14005.16
14005.17
14005.18
14005.19
14005.20
14005.21
14005.22
14005.23
14005.24
14005.25
14005.26
14005.27
14005.28
14005.29
14005.30
14005.31
14005.32
14005.33
14005.34
14005.35
14005.36
14005.37
14005.39
14005.40
14005.41
14005.42
14005.50
14005.60
14005.61
14005.63
14005.64
14005.65
14005.66
14005.67
14005.68
14005.70
14005.73
14005.75
14005.76
14005.84
14005.85
14005.88
14005.89
14005.225
14005.271
14005.275
14005.277
14005.285
14005.287
14005.288
14006
14006.1
14006.01
14006.2
14006.3
14006.4
14006.5
14006.6
14006.7
14006.15
14006.41
14007
14007.1
14007.2
14007.4
14007.5
14007.6
14007.7
14007.8
14007.9
14007.15
14007.45
14007.65
14007.71
14007.95
14007.705
14008
14008.6
14008.7
14009
14009.5
14009.6
14009.7
14010
14011
14011.1
14011.2
14011.3
14011.4
14011.5
14011.6
14011.7
14011.8
14011.9
14011.10
14011.15
14011.25
14011.65
14011.65a
14011.65b
14011.66
14011.75
14011.78
14012.5
14013
14013.3
14013.5
14014
14014.5
14015
14015.1
14015.2
14015.5
14015.7
14015.8
14015.12
14016
14016.1
14016.2
14016.3
14016.4
14016.5
14016.6
14016.7
14016.8
14016.9
14016.10
14016.51
14016.55
14017
14017.1
14017.5
14017.6
14017.7
14017.8
14018
14018.1
14018.2
14018.4
14018.5
14018.7
14019
14019.3
14019.4
14019.5
14019.6
14019.7
14020
14021
14021.2
14021.3
14021.4
14021.5
14021.6
14021.7
14021.8
14021.9
14021.30
14021.31
14021.33
14021.35
14021.51
14021.52
14021.53
14022
14022.1
14022.3
14022.4
14022.5
14023
14023.7
14024
14025
14026
14026.5
14027
14029
14029.5
14029.8
14029.91
14040
14040.1
14040.5
14041
14041.1
14041.5
14042
14000.1
14000.2
14000.03
14000.3
14000.4
14000.05
14000.5
14000.7
14001
14001.1
14001.11
14002
14002.5
14003
14004
14005
14005.1
14005.2
14005.3
14005.4
14005.5
14005.6
14005.7
14005.8
14005.9
14005.10
14005.11
14005.12
14005.13
14005.14
14005.15
14005.16
14005.17
14005.18
14005.19
14005.20
14005.21
14005.22
14005.23
14005.24
14005.25
14005.26
14005.27
14005.28
14005.29
14005.30
14005.31
14005.32
14005.33
14005.34
14005.35
14005.36
14005.37
14005.39
14005.40
14005.41
14005.42
14005.50
14005.60
14005.61
14005.63
14005.64
14005.65
14005.66
14005.67
14005.68
14005.70
14005.73
14005.75
14005.76
14005.84
14005.85
14005.88
14005.89
14005.225
14005.271
14005.275
14005.277
14005.285
14005.287
14005.288
14006
14006.1
14006.01
14006.2
14006.3
14006.4
14006.5
14006.6
14006.7
14006.15
14006.41
14007
14007.1
14007.2
14007.4
14007.5
14007.6
14007.7
14007.8
14007.9
14007.15
14007.45
14007.65
14007.71
14007.95
14007.705
14008
14008.6
14008.7
14009
14009.5
14009.6
14009.7
14010
14011
14011.1
14011.2
14011.3
14011.4
14011.5
14011.6
14011.7
14011.8
14011.9
14011.10
14011.15
14011.25
14011.65
14011.65a
14011.65b
14011.66
14011.75
14011.78
14012.5
14013
14013.3
14013.5
14014
14014.5
14015
14015.1
14015.2
14015.5
14015.7
14015.8
14015.12
14016
14016.1
14016.2
14016.3
14016.4
14016.5
14016.6
14016.7
14016.8
14016.9
14016.10
14016.51
14016.55
14017
14017.1
14017.5
14017.6
14017.7
14017.8
14018
14018.1
14018.2
14018.4
14018.5
14018.7
14019
14019.3
14019.4
14019.5
14019.6
14019.7
14020
14021
14021.2
14021.3
14021.4
14021.5
14021.6
14021.7
14021.8
14021.9
14021.30
14021.31
14021.33
14021.35
14021.51
14021.52
14021.53
14022
14022.1
14022.3
14022.4
14022.5
14023
14023.7
14024
14025
14026
14026.5
14027
14029
14029.5
14029.8
14029.91
14040
14040.1
14040.5
14041
14041.1
14041.5
14042