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For Providers > Eligibility Verification

For Providers - Eligibility Verification

Verify Eligibility

Identification Cards

Medi-Cal members receive a permanent plastic identification card called a Benefits Identification Card or "BIC". This card must be used for identification purposes but does not provide proof of eligibility. Providers must access eligibility information through one of the options made available by CenCal Health. These options include:

SBHI and SLOHI's personal computer software program known as the Provider Network System (PNS)
Direct contact with an CenCal Health eligibility representative

Benefits Identification Card (BIC)

Benefits ID Card

CenCal Health (SBHI & SLOHI) Card

Cencal Member Card

SBHI and SLOHI members will also receive a CenCal Health identification. These cards are issued only once, and reissued only when information on the card changes. These cards are intended only to be a means of identification; they are not to be considered proof of eligibility. Their major purpose is to indicate the member's Primary Care Provider.

Eligibility Verification

Unfortunately, SBHI and SLOHI members may not have an identification card in their possession when in need of care. Providers are responsible for verifying the recipient’s identity and eligibility for services of any Class 1 or Special Class member (and/or determine the PCP for a particular Class 1 member). Several options are available:

1) The Restricted Access Eligibility Verification on our website.
2) Call CenCal Health at 1-877-817-1861 between the hours of 8:00am and 5:00pm on any business day and speak with an eligibility verification representative.

Restricted Access option is available 24 hours a day, 365 days a year. Providers can verify Class 1 and Special Class eligibility. Primary Care Providers can verify Class 1 eligibility by checking the monthly case management list of eligible members in their practice.

EDS offers its own eligibility verification options; these are of limited value to CenCal Health providers as they do not represent information about the member’s Primary Care Provider. EDS options are: a PC software program called Claims and Eligibility Real Time System, or “CERTS”, the EDS Automated Eligibility Verification System (AEVS), and a stand alone device called a Point of Service (POS).

Restricted Access Eligibility Verification

CenCal Health’s Restricted Access page makes checking eligibility very simple. The information required is the Member’s Client Index Number (CIN) found on the Benefits Identification Card (BIC) and the date of service. The CIN number when entered deciphers whether the member is Class 1 or Special Class.

To access the Restricted Section of our website you will need a Username and Password as assigned by CenCal Health. If you do not have a Username and Password, please contact the Provider Services at providerservices@cencalhealth.org. In the e-mail include the name of your company, your Medi-Cal Provider number, NPI number, Tax ID number, name, an e-mail address for authorizations, and a phone number to contact you. Included in the Restricted Section of the website is the ability to use additional functions such as batch eligibility, submitting online claims, share of cost transactions, limited service reservations, and much more.

Further information on the Restricted Section of the website and its functions are explained in the “2008 Website Guide” which is supplied by the Provider Services Department. If you have any questions about the CenCal Health website capabilities, please contact the Provider Services Department at extension 1676.

Eligibility Staff

CenCal Health's Eligibility staff can be contacted directly by calling the main office and dialing 1-877-814-1861 option 3. The representative will request that the provider furnish the member's name, the Client Index Number (CIN), and their Provider Identification Number. If the CIN is not available, the representative will ask for any available information such as the member's full name, birth date, Medi-Cal or Social Security number, gender, or other identifying information. The representative is authorized to provide current eligibility status, and, if necessary, the PCP's name and telephone number, other insurance coverage, and any other necessary information and/or service restrictions. The representative can also verify eligibility for a previous month.

Verify Eligibility