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Data Use Agreement & Medi-Cal Point of Service Network/Internet Agreement 

To receive Medi-Cal eligibility information, LEAs must complete a Data Use Agreement (DUA) or a Medi-Cal Point of Service (POS) Network/Internet Agreement.

Data Use Agreement

The 2018-21 DUA and Attachment D are due to DHCS by January 31, 2019 from all currently participating LEA providers.

LEAs that designate a third-party billing vendor as their 'Custodian of the Files' must submit a DUA, which is signed by representatives of DHCS, the LEA and the vendor. A DUA is required for non-providers (provider representatives, such as a billing vendor) to order and receive Medi-Cal eligibility information on behalf of the LEA. If a LEA does not utilize services of a third-party billing vendor and performs its own in-house billing, the submission of the DUA is not required.

 Please review the attached eight documents:

1.  Data Use Agreement (DUA)

2.  Instructions

3.  Attachment A (Data File Description)

4.  Attachment B (Security Controls)

5.  Attachment C (Notification of Breach)

6.  Attachment D (Certificate of Destruction of Confidential Data)

7.  Attachment E Part I (Custodianship Amendment)

8.  Attachment E Part II (Custodial Contact Change)

 

The Attachments are incorporated into the DUA and apply the same as if they were set out in the body of the Agreement in their entirety. DO NOT RETURN Attachments A, B, and C to DHCS. Attachment D will be returned to DHCS upon renewal or termination of the DUA. Attachment E (Part I and Part II) will be returned to DHCS only if required. 

 

The LEA or consortium responsible for ordering the beneficiary Medi-Cal eligibility information should complete the DUA. The DUA may be submitted to DHCS electronically or by mail. The Instructions explain in detail items 1 through 24 on the DUA, and Attachments A, B, C, D, and E (Parts I and II), and the submission instructions.

 

Please direct questions regarding the DUA and Attachments A-E to LEA@dhcs.ca.gov and include “DUA Question” as part of the subject line.

DUA Q&A (PDF)

LEA Tape Match Record Layout (PDF)

Medi-Cal Point of Service (POS) Network/Internet Agreement

This agreement is required for all providers and non-providers (provider representatives) who intend to use the Medi-Cal POS Network or
Medi-Cal website applications. Contact the Telephone Service Center (TSC) at 1-800-541-5555
 to get started. Outside of California, please call 916-636-1980.
 
Last modified on: 12/17/2018 1:33 PM