Skip to main content

Share Of Cost Management - Cal-PM

  1. Last updated
  2. Save as PDF

Enter share of cost management deductible information for a client.

Avatar PM > Client Management > Account Management > Share of Cost Management

When a service is rendered, the share of cost is the amount the client pays. The Medi-Cal provider assigned to the client pays the balance of the services, after the share of cost has been met for the month.

  • Share of cost liability is incurred for only those months when services are rendered for a client.
  • Share of cost information can be populated through:
    • The Medi-Cal Eligibility Assignment form.
    • When a 271 file is received and posted, with Loop 2110- EB01 (Eligibility or Benefit Information) with the Spend Down amount ( EB*Y*****29*0000025~)
    • Manually entering a share of cost amount in this form.
  • Service liability will distribute to the Medi-Cal guarantor until the share of cost has been cleared.
  • Once the share of cost has been cleared for specific services, liability for services that are used to clear the share of cost will distribute to the next guarantor for the client's self payment.
  • If the share of cost amount has not been met for the month of eligibility, services for that month will remain in an OPEN billing status. The user will not be able to close the services until the SOC has been met.
  • Once Medi-Cal eligibility has been assigned to a client, new share of cost data imported through the California MEDS File Load form will be applied to the associated clients.
  • Any deductible filed in the benefit plan for the client and guarantor will override the information in this form.
  • Share of cost works with Medi-Cal guarantors only.
  • This form is display-only when the share of cost has been met (the SOC Amount (Un-Met) is "0").
  • The Share Of Cost Reversal form can be used to reverse a service from the share of cost amount used when a client's SOC Amount (Un-Met) becomes "$0."

Note:  It is recommended that any spend down amount (share of cost) that will be met by the subscriber be reported through a 270 file from Avatar. If the spend down amount is reported by a source outside of Avatar, the user must manually update the Share of Cost Management form.

SOC Parameters

  1. In the Select Client screen, enter the client ID in the Client Name/ID field, click the Search button, and select the corresponding entry.

  • If the client has previous share of cost management records the Episode Information pre-display shows.
  • Click Add to create a new record. Click Edit to change a record.

  1. In the Financial Class field, select the financial classes that share of cost liability will be distributed to.

  • Date ranges for an individual financial class cannot overlap the date range for the financial class defined in the Medi-Cal Eligibility Assignment, and Medi-Cal File Load forms.
  • Guarantors associated with the financial class are available in the Guarantor field.

  1. In the Effective Date field, enter the share cost deductible start date. This is used to filter the display of services in the Select Rendered Service screen.

  2. In the End Date field, enter the share cost deductible end date. This is used to filter the display of services in the Select Rendered Service screen.

  • The last date of the month populates.
  • The end date must be in the effective date month.
  • If an end date was filed in the Medi-Cal Eligibility form, that date populates this field and can be edited.

  1. In the Episode field, select the client episode.

  2. In the Guarantor field, select the client guarantor. Guarantors are available that have service liability to the guarantor. This is used to filter the display of services in the Select Rendered Service screen.

SOC Amounts

  1. The SOC Amount (Original) field displays the total share of cost amount for the month. If this amount is edited, the amount in the SOC Amount (Un-met) field will change by the same amount.

  2. The SOC Amount (Avatar) field displays the total spend down amount reported by Avatar. This field updates when a 271 file is posted in Avatar.

  3. The SOC Amount (Avatar - Reported Outside Avatar) field displays the share of cost amount met by Avatar, reported through an outside source (for example, called in by a toll-free access number, POS, through the Internet).

  • Enter a positive amount to decrease the total in the SOC Amount (Un-met) field.
  • Enter a negative amount to increase the total in the SOC Amount (Un-met) field.
  • This field must be manually updated if the share of cost amount met by myAvatar is reported through an outside source.

  1. The SOC Amount (3rd Party) field displays the share of cost amount covered by other facilities. This field displays the amount in the Share of Cost Amount (Original) field minus the sum of amounts in the following fields:

  • Share of Cost Amount (Un-met)
  • Share of Cost Amount (Avatar)
  • Share of Cost Amount (Avatar – Reported outside Avatar)

  1. In the SOC Amount (Un-met) field, enter the share of cost amount that has not been met.

  • Decrease the amount in this field - to increase the amount in SOC Amount (3rd Party) field.
  • Increase the amount in this field - to decrease the amount in SOC Amount (3rd Party) field.
  • This field updates when a 271 file is posted in Avatar.
  • This field must be manually updated if the share of cost amount met by myAvatar is reported through an outside source.

Additional Data

  1. The EVC Tracking Number field displays the EVC (eligibility verification confirmation) number.

  • This field updates when a 271 file is posted in Avatar.
  • This field can be manually updated if the share of cost amount met by myAvatar is reported through an outside source.
  • This value populates the TRN segment of 271 eligibility response transactions.
  • TRN is the subscriber trace number, or reference numbers assigned by the information source.
  • The EVC number will not be returned for share of cost clients, until their share of cost has been met for the month of eligibility.

  1. In the Program(s) field, select the treatment programs. This is used to filter the display of services in the Select Rendered Service screen.

  • The share of cost management deductible is distributed to any service for a guarantor in a financial class selected in Financial Class field, and for programs selected in this field.
  • If no programs are selected, all programs are applied to the share of cost deductible.

  1. The SOC Details field displays share of cost information for the client record selected.

  2. Click Select Rendered Service to display the Select Rendered Service screen.

  • Select the service to apply share of cost to, click OK.
  • Closed services are not available.

  1. In the SOC Amount For Service field, enter share of cost amount for the service.

  • This amount cannot be greater than the SOC Amount (Un-Met).
  • A partial service liability amount cannot be entered if the un-met share of cost amount is greater than the total service liability.
  • Partial service liability amount can be entered if the un-met share of cost amount is less than or equal to the total service liability.
    • If the total service liability is less than or equal to the SOC Amount (Un-Met), '0' or the total financial class liability amount can be entered.
    • If the total service liability is greater than the SOC Amount (Un-Met), '0' or the SOC Amount (Un-Met) amount can be entered.

  1. Select File.

  2. Select Review Change History to generate the Medical Eligibility And Share of Cost Management Change History report.

► Registry Settings
► SQL Tables
  • SYSTEM.billing_share_of_cost_evc
  • SYSTEM.billing_share_of_cost_svc
  • SYSTEM.billing_share_of_cost
  • SYSTEM.history_meds_soc_event