The Personal Injury Lien Process
Step 1: Provide notification of injury to establish a new case. The Medi-Cal member or personal representative is required by law to report an action or claim in writing to the Department of Health Care Services (DHCS) pursuant to Welfare and Institutions (W&I) Code section 14124.70 et seq. Establish the new case online or provide notification by mail within 30 days of filing an action or claim. DHCS will send a letter confirming receipt of your notification within 30 days.
The notification must include the following pursuant to W&I Code section14124.73(c):
1. Date of the Medi-Cal member's injury.
2. Member's Medi-Cal Benefits Identification Card number.
3. Contact information of the liable third party or insurer.
4. Contact information of the claims administrator, including their claim number.
5. Contact information of any defense counsel representing the liable third party or insurer.
Step 2: Inform DHCS when the member has completed treatment with a Medi-Cal provider or after the settlement has occurred. Upon each settlement, the member or personal representative is required to notify DHCS pursuant to W&I Code section 14124.785 and 14124.79. When the member has completed treatment or a settlement has occurred, DHCS will order and review the payment records to create a “lien," which is a list of injury-related services subject to collection. Use the Provide a Case Update or Documentation link to inform DHCS of a settlement, completion of treatment, or if you have other case information to report or documentation to provide for an existing case.
If you have questions or require assistance, you can contact the Personal Injury Program at (916) 445-9891 to speak with a live representative or submit an
Online Inquiry to request the status of an active case.
DHCS Lien Overview: Personal Injury
-
Injury is reported to DHCS
In order to proceed with the lien process, the date of injury, primary injury, settlement date, and award value must be provided online (Step 1) or sent by mail to establish a new case. -
DHCS checks for Medi-Cal eligibility
Eligibility verification takes 30 days to complete. Per Welfare and Institutions (WI) Code section 14124.76, no settlement, judgment, or award is final until Medi-Cal has had a reasonable time to produce the Medi-Cal lien. -
If eligible, a Personal Injury case is established
If ineligible, DHCS will notify the submitting party. -
Prior to ordering payment data, DHCS will allow 120 days to pass from the settlement date or final date of treatment, whichever occurred first.
Per (W&I) Code section 14115, providers have up to one year from the date of service to bill Medi-Cal. Providers typically bill Medi-Cal within four months of the date of services. By requesting payment data no earlier than 120 days after the settlement date, DHCS is allowing sufficient time for providers to bill Medi-Cal. -
DHCS may order payment data from Managed Care Plan (MCP)
Data may be ordered from multiple MCPs if the member is enrolled in multiple plans during the treatment period. MCPs usually respond to DHCS' request for records within 30 days. However, additional time may be needed. -
Once payment data arrives, DHCS will review and create a lien, if applicable.
Reviewing the payment data usually takes between 30 days and 60 days. However, additional time may be needed. -
DHCS will send a “lien" or "no lien" letter to the appropriate parties.
Step 3: Pay the Medi-Cal lien. Include the member's DHCS account number to ensure payment is applied to the correct case. You can make a payment by check or
Electronic Funds Transfer (EFT).
For more information on the lien process and timeframes, visit our Frequently Asked Questions page. If funds will be placed into a special needs trust account, please go to the Special Needs Trust website for further instructions on notifying DHCS.
