To open a claim with DHCS you have to obtain the index number. You can obtain the index number in two ways; You can ask the client to send you a picture of their Medi-cal card or you can request the index number via DHCS portal. \*\*\**As of 11/01/2023 you will need the client's social security number to open a claim.\*\*\**

This an example of how the Medi-cal card might look. You will only use the first 9 digits ending with the letter. For example; 91610794A

Select "[[TPLRD Online Inquiries - DHCS - \[CA.gov]]\](<http://CA.gov>)[["]]

Click "[[Medi-Cal Beneficiary Client Index Number Request]]"

Medi-Cal Beneficiary Client Index Number Request

Please notice that the session will expire in 20 minutes, you must submit the needed information before the window times out.

TPLRD Online Inquiry Form



Session expires in 20 minutes.
Note: You must submit this form before the session expires.







Member Medi-Cal Client Index Number (CIN) Request



Welcome to the TPLRD Online Inquiry Form.

This form is for use by authorized parties requesting a member's Medi-Cal Client Index Number (CIN). Please allow 24 business hours for a response.



Section A: Submitter Information



Submitter
Attorney (Plaintiff)
Attorney (Defense)
Third-Party Insurance (Causer's)
First-Party Insurance (Medi-Cal Member's)
Medi-Cal Member
Managed Care Plan
County Office
Other (Specify below):

Other


Submitter's Name


Submitter's Firm/Organization Name


Insurance Claim Number


Phone Number


Email Address


Section B: Medi-Cal Member(s) Information




Authorized users can use this form to request information for up to five Medi-Cal members.







Member One





Last Name


First Name


Date of Birth (MM/DD/YYYY)


Social Security Number (SSN)





Member Two





Last Name


First Name


Date of Birth (MM/DD/YYYY)


Social Security Number (SSN)





Member Three





Last Name


First Name


Date of Birth (MM/DD/YYYY)


Social Security Number (SSN)





Member Four





Last Name


First Name


Date of Birth (MM/DD/YYYY)


Social Security Number (SSN)





Member Five





Last Name


First Name


Date of Birth (MM/DD/YYYY)


Social Security Number (SSN)



Perjury Statement
Check if you agree to the statement below.



By checking this box, I agree that I have been informed of and understand the request instructions and all the information on this form. I also declare under penalty of perjury that the information I have given is true and correct.






This form is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996; this includes regulations regarding various messaging systems used for transmitting patient health information to ensure that the security of patient information via email-based communication is not compromised.

Information Collection and Access



For "**Submitter's Firm/Organization Name**" type "Bauman Law APLC"

Add our office's Phone Number. "(818)-285-0222"

Click the "**Email Address**" and add the email where you would like to received the index number (preferably your Bauman Law personal email)

Use client's Contact card to field Section B.








This form is for use by authorized parties requesting a member's Medi-Cal ID number. Please allow 24 business hours for a response.




Attention:
• This form is no longer required to submit a new case.
• You can now provide the Medi-Cal member's Social Security Number or Medi-Cal ID number on the Personal Injury Notification Form.



Section A: Submitter Information



Submitter
Attorney (Plaintiff)
Attorney (Defense)
Third-Party Insurance (Causer's)
First-Party Insurance (Medi-Cal Member's)
Medi-Cal Member
Managed Care Plan
County Office
Other (Specify below):

Other


Submitter's Name


Submitter's Firm/Organization Name


Insurance Claim Number


Phone Number


Email Address


Section B: Medi-Cal Member Information



Member




Last Name


First Name


Date of Birth (MM/DD/YYYY)


Social Security Number (SSN)*

*SSN is required to receive a member’s Medi-Cal ID number.

Perjury Statement
Check if you agree to the statement below.



By checking this box, I agree that I have been informed of and understand the request instructions and all the information on this form. I also declare under penalty of perjury that the information I have given is true and correct.






This form is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996; this includes regulations regarding various messaging systems used for transmitting patient health information to ensure that the security of patient information via email-based communication is not compromised.

Information Collection and Access

Information about any claim or legal action you may take is requested by authority of the Welfare and Institutions Code Sections 10020, 10022, 10024, 14000, 14023, 14024, and 14124.70 through 14124.79, and Title 22, California Code of Regulations, Section 50771. We use your social security number provided under the Title 22, California Code of Regulations, Section 50187 and other information for contacting insurance companies, providers of health care, county agencies, or attorney. The informa

Add client's **Date of Birth (MM/DD/YYYY)**.

Add client's Social Security Number (SSN). \*\* SSN does not come in the intake. Please call the client and ask for the SSN.

Click the "Check if you agree to the statement below."

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Submitting a Personal Injury Claim through DHCS

Request Index Number