Report a New Case and Case Updates – Online Forms
The Department of Health Care Services’ (DHCS) Personal Injury (PI) Program is required by federal and state law to recover funds for Medi-Cal paid services related to a liable third party action when a member receives a settlement, judgment, or award. The information below will help you submit proper notification to DHCS, but you must complete the appropriate form in its entirety and review for accuracy. For security purposes, we do not accept digital media.
报告新案例（步骤 1）：
为每位涉及人身伤害事故的 Medi-Cal 会员提交一份新的案件通知。多次提交可能导致延迟处理。新病例通知必须包括以下内容，以满足 W&I Code 第 14124.73(c) 节规定的报告要求：
- Date of the Medi-Cal member’s injury.
- 会员福利识别卡（BIC）上所列的加州医疗保险 ID 编号或社会安全编号。
- Contact information of the liable third party or insurer.
- 保险索赔管理人的联系信息，包括索赔编号。
- 代表责任第三方或保险公司的辩护律师的联系信息。
Allow 30 days for DHCS to send a letter confirming receipt of the notification. If the injured party is Medi-Cal eligible, the letter will detail DHCS’ recovery rights and lien process.
The Medi-Cal ID number can be found on the member’s Medi-Cal Benefits Identification Card (BIC) shown below. The member’s Medi-Cal ID number is comprised of the first 9 characters, beginning with “9,” followed by 7 additional numbers, and ending with a letter. If you do not have the member’s Medi-Cal ID number, you can enter the member’s Social Security Number.
案例更新（第 2 步）：
- Provide a case update when the member has completed treatment with a Medi-Cal provider or after the settlement has occurred. DHCS will order and review the payment records, then send the Medi-Cal lien.
- 如果您有新的信息需要报告或有现有案件需要提供的文件，请提供案件更新信息。 出于安全目的，我们不接受数字媒体。
人身伤害（PI）
PI – Step 1
报告新案件（人身伤害通知表）
PI – Step 2
提供案例更新或文档（所有其他通知）
PI – Step 3
在线支付 Medi-Cal 留置权
其他
请求未结案件的状态
工伤赔偿（WC）
WC – Step 1
向现有索赔提交新的索赔通知或信息
Please Note: a response will be provided only if DHCS is asserting a Medi-Cal lien.
WC – Step 2
Pay online