23-1191 Reminder: List Social Determinants of Health Data on Claims or Encounters
Date: 10/13/23
Identifying member health, social and risk needs ensures members receive specific services and programs they require
Capturing social determinants of health (SDOH) data is a critical step in evaluating population health. This is done by reviewing member traits, health, social and risk needs. The emphasis is to improve health equity and identify health disparities and their root causes. This data will also aid in planning and coordinating care as well as providing personalized care to your patients.
How to submit SDOH data
Refer to the 18 Department of Health Care Services (DHCS) priority SDOH codes below when documenting SDOH as they relate to your patient. Submit these on claims or encounters. The codes are based on the ICD-10-CM.
Be part of the CalAIM’s Population Health Management initiative
Your support in providing SDOH data is vital to the success of the California Advancing and Innovating Medi-Cal (CalAIM) Population Health Management (PHM) initiative. CalAIM’s PHM initiative identifies and manages member risk and need through whole-person care approaches while focusing on and addressing SDOH.
DHCS Priority SDOH Codes
Code | Description |
|---|---|
Z55.0 | Illiteracy and low-level literacy |
Z59.0 | Homelessness |
Z59.1 | Inadequate housing (lack of heating/space, unsatisfactory surroundings) |
Z59.3 | Problems related to living in residential institution |
Z59.4 | Lack of adequate food and safe drinking water |
Z59.7 | Insufficient social insurance and welfare support |
Z59.8 | Other problems related to housing and economic circumstances (foreclosure, isolated dwelling, problems with creditors) |
Z60.2 | Problems related to living alone |
Z60.4 | Social exclusion and rejection (physical appearance, illness or behavior) |
Z62.819 | Personal history of unspecified abuse in childhood |
Z63.0 | Problems in relationship with spouse or partner |
Z63.4 | Disappearance and death of family member (assumed death, bereavement) |
Z63.5 | Disruption of family by separation and divorce (marital estrangement) |
Z63.6 | Dependent relative needing care at home |
Z63.72 | Alcoholism and drug addiction in family |
Z65.1 | Imprisonment and other incarceration |
Z65.2 | Problems related to release from prison |
Z65.8 | Other specified problems related to psychosocial circumstances (religious or spiritual problem) |
Additional information
Providers are encouraged to access the provider website for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact California Health & Wellness Plan (CHWP) at 877-658-0305.
This information applies to Physicians, Independent Practice Associations (IPAs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.