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Common Words and Phrases

Like many other Managed Care Health Plans, CenCal Health uses similar words and phrases related to healthcare services. Healthcare operations within CenCal Health that use abbreviated terminology many times include authorizations and/or approvals, referrals, different types of physicians, providers, claims processing. Also government and community based organizations use these words and phrases which can be confusing.

CenCal Health’s goal is to NOT use this terminology when assisting members, providers, government agencies and community based organizations.

Primary Care Physician/Provider (PCP)

This is the physician/doctor or clinic that members are assigned to for routine and preventative care. The PCP will provide prescriptions and oversee sending patients to specialty doctors and/or other providers.

Americans with Disability Act (ADA)

CenCal Health contracts with providers that are accessible to the disabled requiring access to wheelchairs in examination rooms, bathrooms, waiting areas, scales and to examination tables that are able to raise and lower.

Benefits Identification Card (BIC)

The BIC card is a blue and white plastic Medi-Cal card provided by the State. This card has a magnetic strip on the back that allows providers to determine a patient’s Medi-Cal eligibility status. Members should carry this card at all times.

California Children’s Services

This program provides medical services to disabled children or those with serious and chronic medical conditions.

Community Based Adult Services (CBAS)

These day services are available to disabled adults and seniors that have health problems that make it hard for them to take care of themselves and need extra help. Services include assistance with daily living such as bathing, feeding, dressing and taking medication.

Child Health and Disability Prevention (CHDP)

This program provides children with preventative services such as well child visits and immunizations (shots).

Department of Social Services (DSS)

The Department of Social Services provides many services for local residents. The also assist residents with obtaining Medi-Cal, Cash Assistance, Cal Fresh (food stamps) and housing assistance. DSS eligibility workers determine eligibility for all social services programs.

Durable Medical Equipment (DME)

This phrase is equipment that is prescribed by a CenCal Health provider to meet the medical needs of the member such as wheelchairs, walkers, crutches, etc.

Dual Eligible / Medi-Medi

Members that are over 65 years of age, qualify for Medicare and also for Medi-Cal. Medi-Cal coordinates with Medicare for hospitalization, Part A and professional services, Part B and medication coverage, Part D.

Emergency Department (ED)

Emergency Departments are located at hospital facilities and are often referred to as EDs. These departments provide emergency services.

Federally Qualified Health Center (FQHC)

FQHCs are provided funding through the Federal Government and State as the safety net providers. These clinics provide primary, specialty and mental health services.

Medical Request Form (MRF)

This form is completed by the prescribing physician/doctor and sent to CenCal Health for prior approval before medications can be filled. Not all medications require this process, which is based on medical justification.

Other Healthcare Coverage

Medi-Cal coordinates with other healthcare coverage for members. Members with other healthcare coverage must use their primary coverage first, as Medi-Cal will be the secondary coverage.

Referral Authorization Form (RAF)

This is a prior authorization (approval) process to see specialty providers. The Primary Care Provider uses this form to request approval from CenCal Health for those specialty services.

Share Of Cost (SOC)

This is the amount some members may be required to pay each month to providers for their medical services and care. The amount depends on a member’s income and is determined by the Eligibility Worker at the local Department of Social Services. Once this share of cost has been met, they become eligible with CenCal Health and receive additional services at no cost for the remainder of the month.

Treatment Authorization Request (TAR)

This process is known as obtaining (getting) approval from CenCal Health for procedures and treatment for medical services before the medical treatment or procedure is rendered (given).

Tri-Counties Regional Center (TCRC)

The Tri-Counties Regional Center provide numerous services to developmentally disabled children and adults.

Women, Infants & children Program (WIC)

The WIC Program provides food vouchers and nutrition education for pregnant and breast feeding women with infants and children up to the age of 5.