Adult Medicaid Change Notices

A. MA-2400 – Reference to MA-2041, Third Party Recovery Insurance Information, has been changed to TA Screen/TU Screen through out this manual section.

B. MA-2400, II. B. 3. and 4. – Receipt of invalid insurance information is directed to VII. 2. A. Reference to end dating insurance policies six months after a Medicaid case has been closed is deleted.

C. MA-2400, VII

A. NCXPTR COUNTY REPORT-DHREHC NCHC/BCCM TPR COUNTY REP

B. NCXPTR STATE REPORT- DHREHC NCHC/BCCM TPR STATE REP

A. Remove: MA-2400, Third Party Recovery, pages 1- 4 and 7-10.

CHANGE NOTICE FOR MANUAL No. 24-10, THIRD PARTY RESOURCES

DATE: 12/23/10

Manual: Aged, Blind, and Disabled Medicaid

Change No: 24-10

To: County Directors of Social Services

Effective: 01/01/11

Make the following change(s)

I. BACKGROUND

DMA contracts with a vendor, currently HMS, to complete a data match with multiple insurance databases to search for comprehensive, pharmacy, and other types of insurance for Medicaid recipients. On January 1, 2011, the data match will be extended to North Carolina Health Choice (NCHC) and Breast and Cervical Cancer Medicaid (BCCM).

Previously EIS edits prevented the keying of comprehensive third party resource data to an ongoing NCHC or BCCM case. On January 4, 2011, the EIS edits will be removed to allow third party resource keying on NCHC and BCCM cases.

Currently EIS end dates insurance policies six months after an individual is terminated from Medicaid. EIS will stop end dating insurance for NCHC, BCCM, and Medicaid recipients beginning January 1, 2011. Third party resource status must be checked for applications and reviews utilizing the TPR (TA/TU) screens.

II. Content of change

MA-2400, Third Party Recovery, is revised to provide instruction concerning two new TPR reports, DHREHC NCHC/BCCM TPR COUNTY REP and DHREHC NCHC/BCCM TPR STATE REPORT, and a new form, DMA-5055, Third Party Resource Transmittal.

A. MA-2400 – Reference to MA-2041, Third Party Recovery Insurance Information, has been changed to TA Screen/TU Screen through out this manual section.

B. MA-2400, II. B. 3. and 4. – Receipt of invalid insurance information is directed to VII. 2. A. Reference to end dating insurance policies six months after a Medicaid case has been closed is deleted.

C. MA-2400, VII

1. All third party resource information keyed into EIS (TA Screen/TU Screen) for NCHC and BCCM cases will generate a report in NCXPTR, DHREHC NCHC/BCCM TPR COUNTY REP. This report replaces the letters from Program Integrity that previously notified the counties of potential third party resource information that could affect NCHC and BCCM eligibility. The report is run weekly on Friday evening and is available the first working day of the week. County workers may key third party resources for NCHC and BCCM beginning 1/4/11. The first weekly County report is available 1/10/11. Review the report to determine if the third party resource is valid or invalid/non-applicable to the case. Take appropriate action.

2. The state report, DHREHC NCHC/BCCM TPR STATE REP, is generated monthly. The MPRs will have access to this report and will review to ensure that counties are working the County report. This report will be run the last working day of the month and have a lag time of two months. The monthly State report generated the last working day of March will show January’s data.

3. A new form, DMA-5055 Third Party Resource Transmittal, is created to send invalid/non-applicable third party resource information to Third Party Recovery Section. This information is needed by TPR to block further transmission of invalid insurance information.

III. new eis ncxptr reports

A. NCXPTR COUNTY REPORT-DHREHC NCHC/BCCM TPR COUNTY REP

The report lists active NCHC and BCCM recipients for whom insurance was keyed in EIS. All types of insurance are captured. The report is run each week on Friday night beginning on Friday, January 7, 2011. Each report will be retained in NCXPTR for 1095 days. County workers should only be able to view data for their county.

The following data elements are included on the report:

1. County name and Number

2. EIS Case ID

3. EIS District Number

4. Casehead Name

5. Insured’s Name

6. Individual ID of Insured

7. TPR District Number (Identifies who keyed the insurance)

8. Insurance Type Code

9. Insurance Company Code

10. Insurance Policy Number.

11. Aid Program Category (APC)

12. Medicaid Classification

The report is sorted by County, EIS District Number, and then by who keyed the

insurance (HMS, TPR, Other).

B. NCXPTR STATE REPORT- DHREHC NCHC/BCCM TPR STATE REP

The report lists the active NCHC and BCCM recipients for whom insurance was keyed in EIS and indicates the current status (active/inactive) of the recipient at the time the report is run. The report is run each month on the last work night of the month beginning on Thursday, March 31, 2011. Each report will be retained in NCXPTR for 1095 days. The state report contains the information from the county weekly reports from the prior period. For example, the state report for March will contain what the county found out about in January.

The following data elements are included on the report:

1. County name and Number

2. EIS Case ID

3. EIS District Number

4. Casehead Name

5. Insured’s Name

6. Individual ID of Insured

7. TPR District Number (Identifies who keyed the insurance)

8. Insurance Type Code

9. Insurance Company Code

10. Insurance Policy Number

11. Aid Program Category (APC)

12. Medicaid Classification

13. Termination Reason (if applicable)

The report is sorted by County, Active or Inactive, and then by who keyed the

insurance (HMS, TPR, Other).

IV. Effective Date and implementation

Apply this policy to any applications or redeterminations taken or in process on or after January 1, 2011.

V. Maintenance of Manual

A. Remove: MA-2400, Third Party Recovery, pages 1- 4 and 7-10.

Insert: MA-2400, Third Party Recovery, pages 1- 4 and 7-12 dated 1/1/11.

If you have any questions regarding this information, please contact your Medicaid Program Representative.

Craigan L. Gray, MD, MBA, JD,

Director

(This material was researched and written by John Benske, Policy Consultant, Medicaid Eligibility Unit.)