For initial setup for submitting claims on behalf of the counties to Medi-Cal, CCIH will need:

• Initial list of Providers for which the county will be submitting claims.
• County submitter ID and Password. This information will be provided from DHCS to the counties per our understanding.

Information that will be needed with each submission.

1. Patient demographics (from Medi-Cal’s  Meds Record, may or may not match what is on the claim)

• Last Name
• First Name
• Gender
• DOB
• Medi-Cal Client Identification Number (CIN)

2. Claim information (from Claim and/or from County records)

• Service begin date
• Service end date
• Billed charges
• Date the claim was paid by county
• Paid amount from county to provider (check#, amount)

3. Ongoing information exchange

• Changes to providers, particularly adding new providers
• Your County’s Ad-Hoc report from DHCS to finalize claims in CCIH system and for reporting purposes.

Pricing Structure

• An initial set-up fee of $650
• A per claim fee of $20

Pricing structure includes the loading of a maximum of twenty (20) providers per county.  Additional costs may apply per provider beyond the maximum number.