OHC

Other Health Coverage (OHC) codes. This data element identifies a recipient's private health care coverage by a health care insurance company, a Prepaid Health Plan (PHP), Health Maintenance Organization (HMO), or a Public Institution. It indicates that health care services should, in most cases, be covered by the private health care coverage instead of Medi-Cal. This field can be viewed from the INQM or INQC screen

Effective January 1, 2017, four (4) new OHC codes, E, H, Q, and W has been added to into MEDS.

Pay and Chase OHC (Post Payment Recovery)
A	Any Carrier including multiple coverage.
Cost Avoidance OHC
C	Champus Prime HMO (Military Benefits Comprehensive)
D	Medicare Part D Prescription Drug Coverage
E	Vision Plans
F	Medicare Risk HMO (Medicare Part C Health Plan)
G	Medical Parole
H	Multiple Plans Comprehensive
K	Kaiser
L	Dental only policies
P	PPO/PHP/HMOs and EPO (Exclusive Provider Option) not otherwise specified
Q	Commercial Pharmacy Plans
V	Any carrier (other than above, includes multiple coverage). This code is obsolete as of January 1, 2017, but historically maintained in MEDS for 36 months prior to January 2017.
W	Multiple Plans Non-Comprehensive
Other OHC Related Codes
N	None
O	Override - Used to remove cost avoidance OHC codes posted by DHCS Recovery when OHC Source is H, R or T. Changes OHC to A.