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.
報告新案例（步驟 1）：
為每名涉及人身傷害事件的 Medi-Cal 會員提交一份新個案通知。多次提交可能會導致處理延遲。根據 W&I Code 第 14124.73(c)節，新個案通知必須包括以下內容，以滿足報告要求：
- Date of the Medi-Cal member’s injury.
- 會員在福利識別卡 (BIC) 上列出的 Medi-Cal ID 號碼，或社會安全號碼。
- Contact information of the liable third party or insurer.
- 保險理賠管理員的聯絡資訊，包括其理賠號碼。
- 代表責任第三方或保險人的任何辯護律師的聯絡資訊。
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（步驟 2）：
- 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.
- 如果您有新資訊要報告，或為現有個案提供的文件，請提供案例更新。 基於安全考量，我們不接受數位媒體。
人身傷害（PI）
PI – Step 1
舉報新個案（人身傷害通知表格）
PI – Step 2
提供案例更新或文件（所有其他通知）
PI – Step 3
在線支付加州醫療補助健康保健計劃留置權
其他
索取未開案件的狀態
工人補償（WC）
WC – Step 1
向現有索償提交新的索償通知或資訊
Please Note: a response will be provided only if DHCS is asserting a Medi-Cal lien.
WC – Step 2
Pay online