Eligibility Information System Table of Contents

EIS 1000 – INTRODUCTION

I. SYSTEM OVERVIEW

II. SECURITY

III. CONFIDENTIALITY

IV. HOW TO USE THIS MANUAL

EIS 1050 – EIS INQUIRY

I. GENERAL INFORMATION

II. LOGON PROCEDURES

III. LOGOFF PROCEDURES

EIS 1051 - APPLICATION INQUIRY

I. GENERAL INFORMATION

II. ACCESS PROCEDURES

EIS 1052 - CASE LEVEL INQUIRY

I. GENERAL INFORMATION

II. CURRENT CASE DATA (CD)

III. CASE HISTORY (CH)

IV. ALL INDIVIDUALS IN A CASE (CI)

V. CASE MULTI-VALUES (CM)

VI. DSS-8125/8126 AND NOTICE INQUIRY (5)

EIS 1053 - CHECK HISTORY INQUIRY

I. GENERAL INFORMATION

II. ACCESS PROCEDURES

III. CHECK HISTORY CODES

IV. AID PROGRAM/CATEGORY CODES

EIS 1054 - INDIVIDUAL INQUIRY

I. GENERAL INFORMATION

II. SCROLLING THROUGH THE CASE INDIVIDUALS (CI)

III. CURRENT INDIVIDUAL DATA (ID)

IV. INDIVIDUAL PROFILE (IP)

V. INDIVIDUAL MEDICAID ELIGIBILITY (IE)

vi. INDIVIDUAL MEDICARE A/B DATA (MB)

VII. INDIVIDUAL MEDICARE C (MC)

VIII. INDIVIDUAL MEDICARE D ENTITLEMENT DATA (MD)

IX. INDIVIDUAL MEDICARE D Enrollment DATA (ME)

X. PACE/MANAGED CARE HISTORY INQUIRY (MI)

XI. ASSETS TRANSFER INQUIRY/UPDATE (AT)

EIS 1055 - THIRD PARTY HEALTH AND ACCIDENT RESOURCE INFORMATION INQUIRY

I. GENERAL INFORMATION

II. TPR POLICY INQUIRY (TP)

III. TPR INDIVIDUAL INQUIRY (TI)

IV. INSURANCE COMPANIES BY NAME OR CODE

EIS 1056 – COMMON NAME DATABASE TABLE OF CONTENTS

EIS 1056 - COMMON NAME DATABASE

I. NAME/SSN SEARCH/ID ASSIGNMENT

II. ABSENT PARENT DATABASE

iii. MULTIPLE INDIVIDUAL ID RESOLUTION

IV. CASE ID SEARCH

V. CHANGES TO DATA IN THE COMMON NAME DATABASE

VI. PAYEE SEARCH

EIS 1057 - MASTER CLIENT INDEX (MCI) TABLE OF CONTENTS

EIS 1057 – MASTER CLIENT INDEX (MCI)

I. GENERAL INFORMATION

II. HOW MCI IS UPDATED

III. LOGON PROCEDURES

IV. MCI SUB MENU

V. INQUIRY FUNCTIONS

VI. LOGOFF PROCEDURES

VII. THE MATCH REPORT

EIS 1059 – WORKER/SUPERVISOR INQUIRY AND UPDATE

I. GENERAL INFORMATION

II. ACCESS INFORMATION

III. WORKER/SUPERVISOR UPDATE INFORMATION

EIS 1060 – WORK FIRST/TRANSITIONAL QUARTERLY REPORTING INQUIRY

I. GENERAL INFORMATION

II. LOGON PROCEDURES

III. VIEWING THE Quarterly REPORTING DATABASE

IV. STATUS CODES DEFINED

V. REPORT NUMBERS DEFINED

VI. QR TYPE DEFINED

VII. MOVING TO OTHER IMS FUNCTIONS

VIII. LOGOFF PROCEDURES

EIS 1061 – X/PTR – REPORT DISTRIBUTION SYSTEM

I. GENERAL INFORMATION

II. ACCESS PROCEDURES

III. X/PTR LATEST REPORTS OPTIONS

IV. VIEWING THE REPORTS

V. LOGOFF PROCEDURES

VI. SIGNING ON TO X/PTR FOR THE FIRST TIME

VII. SETTING THE PRINTER DEFAULTS

VIII. MODIFYING YOUR USER PROFILE

IX. REPORT NAMES AND ACCESS CODES-These are the most commonly used reports.

EIS 1062 – TRANSITIONAL BENEFITS REPORTS TRACKING INQUIRY

I. GENERAL INFORMATION

II. LOGON PROCEDURES

III. REPORT RESPONSE CODES DEFINED

IV. MOVING TO OTHER IMS FUNCTIONS

EIS 1063 – AUTOMATED DMA - 5016

I. GENERAL INFORMATION

II. DETERMINING THE FACILITY CODE

III. FACILITY CODE VALIDATION

IV. SAMPLE AUTOMATED DMA-5016

V. PML REGISTER

EIS 1101 – DEPARTMENT OF TRANSPORTATION (DOT) INQUIRY

I. GENERAL INFORMATION

II. LOGON PROCEDURES

III. INQUIRY OPTIONS

IV. INQUIRY KEYS

V. PRIMARY SCREEN DESCRIPTIONS

VI. TAX VALUE OPTION

VII. PF KEY FUNCTIONS

VIII. LOGOFF PROCEDURES

EIS 1102 – DEPARTMENT OF CORRECTIONS (Public OFFENDER WEBSITE) INQUIRY

I. GENERAL INFORMATION

II. LOGON

III. SEARCH OPTIONS

IV. LOGOFF

EIS 1103 – SOCIAL SECURITY NUMBER VALIDATION

I. GENERAL INFORMATION

II. HOW THE VALIDATION PROCESS WORKS

III. RESOLVING DISCREPANCIES WHEN INCORRECT DATA VALIDATES

IV. BENDEX VALIDATION

V. SSN VALIDATION DISCREPANCY REPORT

VI. SSN VALIDATION REMINDER REPORT

VII. REQUESTS FOR MANUAL VALIDATIONS

Eis 1104 - beneficiary data exchange (bendex)

EIS 1104 – BENEFICIARY EXCHANGE (BENDEX)

I. GENERAL INFORMATION

II. BENDEX PROCESSING

III. BENDEX INFORMATION SHEET

IV. OnLine Verification System Information:

IV. D. HIB Entitlement (Part A)

HIB Entitlement (Part A)

IV. E. SMI (Supplemental Medical Insurance) Entitlement (PartB)

SMI Entitlement (Part B)

IV. F. Payment History

Payment History

IV. G. Logoff Procedures

V. USE OF FORMS

VI. MESSAGE LIST

VII. DEFINITION LISTING

VIII. SSA SYSTEMS INTERFACE IDENTIFICATION CODES

EIS 1105 - STATE DATA EXCHANGE (SDX) TABLE OF CONTENTS

EIS 1105 – STATE DATA EXCHANGE (SDX)

I. GENERAL INFORMATION

II. HOW SDX IS UPDATED

III. ON-LINE INQUIRY and online verification system

V. SDX INFORMATION SHEETS

VI. ADDITIONAL INFORMATION

VII. SDX HISTORY

EIS 1106 – EMPLOYMENT SECURITY COMMISSION INQUIRY (ESC)

I. GENERAL INFORMATION

II. UPDATES

III. LOGON PROCEDURES

IV. INFORMATION ON THE SCREENS

V. LOGOFF

EIS 1107 – STATE ONLINE QUERY/THIRD PARTY QUERY

I. GENERAL INFORMATION

II. ACCESSING THE THIRD PARTY QUERY

III. REQUIRED INTERFACE INQUIRIES

IV. INITIATING A tpQY REQUEST

V. RETRIEVING THIRD PARTY QUERY REQUESTS

VI. NAVIGATION AND RETENTION

VII. INFORMATION ON THE TPQY RESPONSE RECORD

VIII. LOGOFF PROCEDURES

EIS 1108 – SAVE VERIFICATION INFORMATION SYSTEM

I. GENERAL INFORMATION

II. ACCESSING THE SYSTEM

III. CASE ADMINISTRATION

IV. USER ADMINISTRATION

V. SITE ADMINISTRATION

VI. ADDITIONAL RESOURCES

VII. Logoff

EIS 1109 – ONLINE VERIFICATION (OLV)

EIS 1200 – STATE OFFICE CONTACTS

I. DIVISION OF INFORMATION RESOURCE MANAGEMENT (DIRM)

II. DIVISION OF MEDICAL ASSISTANCE (DMA)

III. DIVISION OF SOCIAL SERVICES (DSS)

IV. DIVISION OF AGING AND ADULT SERVICES (DAAS)

V. IEVS COORDINATOR

Vi. Online FORMS

ViI. Printed forms

EIS 1201 – BROADCAST MESSAGES

I. GENERAL INFORMATION

II. RECEIVING BROADCAST MESSAGES BY EMAIL

EIS 1250 – GLOSSARY

EIS 2010 - COMPLETING AN APPLICATION FORM – INTRODUCTION

I. GENERAL INFORMATION

II. APPLICATION TYPES

III. SPECIAL SITUATIONS

IV. CODES

V. DENIALS AND WITHDRAWALS

VI. DSS-8124 ROUTING

VII. DSS-8124I APPLICATION TURNAROUND

VIII. ON-LINE INQUIRY

IX. AID PROGRAM/CATEGORY CHART

X. IF A NEW APPLICATION OR REAPPLICATION IS REQUIRED, TURN TO THE APPROPRIATE AID PROGRAM/CATEGORY INSTRUCTIONS WITHIN THIS VOLUME TO COMPLETE THE APPLICATION FORM.

XI. IF AN AID PROGRAM/CATEGORY TRANSFER IS ALLOWED, TURN TO GENERAL INSTRUCTIONS FOR AID PROGRAM/CATEGORY TRANSFERS, EIS 3450, FOR FURTHER INSTRUCTIONS.

EIS 2011 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS AND REAPPLICATIONS MEDICAID TO THE AGED, BLIND, AND DISABLED

I. GENERAL INFORMATION

II. COMPLETING AN APPLICATION FORM

III. OUTPUT

IV. ADMINISTRATIVE APPLICATIONS

EIS 2012 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS, REAPPLICATIONS, AND ADD-AN-INDIVIDUAL APPLICATIONS FOR M-AF, M-IC, M-PW, AND M-RF

I. GENERAL INFORMATION

II. COMPLETING THE INPUT SCREEN

III. OUTPUTS

IV. ADMINISTRATIVE APPLICATIONS

V. Dual Eligibility – MEDICALLY NEEDY (MAF-M or MAD-M) and Family Planning (MAF-D)

EIS 2013 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS AND REAPPLICATIONS FOR I—AS AND H—SF

I. GENERAL INFORMATION

II. COMPLETING AN APPLICATION FORM

III. OUTPUTS

EIS 2015 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS, REAPPLICATIONS, AND ADD-AN-INDIVIDUAL FOR S-AA, S-AD, AND S-CD

I. GENERAL INFORMATION

II. COMPLETING AN APPLICATION FORM

III. OUTPUTS

EIS 2051- MAKING CHANGES TO MEDICAID APPLICATIONS

I. GENERAL INFORMATION

II. THE FOLLOWING INFORMATION MAY BE CORRECTED ON AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM ON THE NAME CHANGE SCREEN:

III. THE FOLLOWING INFORMATION MAY BE CORRECTED ON AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM ON THE DSS-8124I:

IV. THE FOLLOWING INFORMATION MAY NOT BE CHANGED ON AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM:

V. CHANGE OF CASEHEAD/PAYEE - See EIS 3101 for detailed instructions for casehead/payee change.

VI. CHANGE OF NOTICE OVERRIDE

VII. SIGN AND DATE THE APPLICATION OR APPLICATION TURNAROUND.

VIII. KEY THE CHANGES.

IX. OUTPUT

EIS 2052 - MAKING CHANGES TO SA APPLICATIONS

I. GENERAL INFORMATION

II. THE FOLLOWING INFORMATION MAY BE CORRECTED ON THE NAME CHANGE SCREEN for AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM:

III. THE FOLLOWING INFORMATION MAY BE CHANGED ON the DSS-8124I for AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM:

IV. THE FOLLOWING INFORMATION MAY NOT BE CHANGED ON AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM:

V. CHANGE OF NOTICE OVERRIDE

VI. SIGN AND DATE THE APPLICATION OR APPLICATION TURNAROUND.

VII. SUBMIT THE CHANGED APPLICATION TURNAROUND AND/OR THE NEW DSS-8124 TO DATA ENTRY FOR KEYING.

VIII. OUTPUTS

EIS 2150 - DENYING AN APPLICATION

I. GENERAL INSTRUCTIONS

II. DENYING ONE PART APPLICATIONS (Application Types 1, 2, and 6)

III. DENYING TWO PART APPLICATIONS (Application Types 4 and 5)

IV. NOTICE OVERRIDE

V. SIGNATURE AND DATE

VI. SUBMIT THE DSS-8124 TO DATA ENTRY THE DAY YOU COMPLETE THE DENIAL ACTION FOR KEYING.

VII. OUTPUTS

VIII. GENERAL INFORMATION FOR AUTOMATED DENIAL NOTICES

IX. SYSTEM GENERATED DSS-8109A

X. THE MANUALLY ISSUED DSS-8109

EIS 2200 - WITHDRAWING AN APPLICATION

I. GENERAL INSTRUCTIONS

II. WITHDRAWING ONE-PART APPLICATIONS (Application Types 1, 2, and 6)

III. WITHDRAWING TWO-PART APPLICATIONS (Application Types 4 and 5)

IV. NOTICE OVERRIDE

V. SIGNATURES AND DATE

VI. SUBMIT THE DSS-8124 TO DATA ENTRY FOR KEYING.

VII. OUPUTS

VIII.GENERAL INFORMATION FOR AUTOMATED WITHDRAWAL NOTICES

IX. THE SYSTEM GENERATED DSS-8109A

EIS 2240 – AUTHORIZED REPRESENTATIVE

I. GENERAL INFORMATION

II. EIS KEYING INSTRUCTIONS

III. EIS AUTOMATED NOTICES

IV. REPORTS

V. Client Service Data Warehouse (CSDW)

EIS 2251 - APPROVING M-AA, M-AB, AND M-AD NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUT

V. AUTOMATED NOTICES

EIS 2252 - APPROVING M-SB NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

IV. OUTPUT

V. AUTOMATED NOTICES

EIS 2253 - APPROVING M-QB NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. APPROVING APPLICATIONS

III. COMPLETING THE DSS-8125

IV. KEY THE DSS-8125.

V. OUTPUT

VI. AUTOMATED NOTICES

EIS 2254 – APPROVING M-AF AND M-RF NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125 AND DSS-8126's.

Iv. OUTPUTS

V. AUTOMATED NOTICES

EIS 2255 – APPROVING M-IC NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

ii. COMPLETING THE DSS-8125

III. KEY THE DSS-8125 and DSS-8126's.

IV. OUTPUTS

V. AUTOMATED NOTICES

EIS 2256 – APPROVING M-PW NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES

EIS 2257 - APPROVING AN M-AF, M-RF, AND M-IC ADD-AN-INDIVIDUAL APPLICATION

I. GENERAL INFORMATION

II. SPECIAL SITUATIONS

III. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

IV. COMPLETING THE DSS-8125

V. KEY THE DSS-8125 AND THE DSS-8126's.

VI. OUTPUTS

VII. AUTOMATED NOTICES

EIS 2258 - APPROVING I-AS (TITLE IV-E FOSTER CARE/ADOPTION ASSISTANCE) NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES

EIS 2259 – APPROVING H-SF (NON TITLE IV-E FOSTER CARE) NEW APPLICATIONS OR REAPPLICATIONS

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES

EIS 2264 – APPROVING AN S-AA OR S-AD NEW APPLICATION OR REAPPLICATION

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. SUBMIT THE DSS-8125 AND SUPPLEMENTAL NOTICE INFORMATION FORM TO DATA ENTRY FOR KEYING.

IV. OUTPUTS

V. AUTOMATED NOTICES

EIS 2265 – APPROVING AN S-CD NEW APPLICATION OR REAPPLICATION

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. SUBMIT THE DSS-8125, DSS-8126 AND SUPPLEMENTAL NOTICE INFORMATION FORM TO DATA ENTRY FOR KEYING.

IV. OUTPUTS

V. Automatic Notices

EIS 2266 – APPROVING AN S-CD ADD-AN-INDIVIDUAL APPLICATION

I. GENERAL INFORMATION

II. SPECIAL SITUATIONS

III. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

IV. COMPLETING THE DSS-8125

V. SUBMIT THE DSS-8125 AND SUPPLEMENTAL NOTICE INFORMATION FORM TO DATA ENTRY FOR KEYING.

VI. OUTPUTS

VII. AUTOMATED NOTICES

EIS 2268 - DMA-5022 INSTRUCTIONS SPECIAL ASSISTANCE application approvals

I. USE THE DMA-5022 WHEN APPROVING AN APPLICATION TO:

II. COMPLETE SECTION A OF THE DMA-5022 TO REQUEST ANY BENEFIT LISTED IN II. ABOVE. FOLLOW THE INSTRUCTIONS BELOW.

III. DO NOT COMPLETE SECTION B OF THE DMA-5022 TO AUTHORIZE RETROACTIVE MEDICAID BENEFITS YOU CANNOT AUTHORIZE USING THE DSS-8125. You must use the DB/PML function. See EIS 3105.

IV. COMPLETE SECTION C OF THE DMA-5022 TO REQUEST MONEY PAYMENT BENEFITS. FOLLOW THE INSTRUCTIONS BELOW TO REQUEST THE APPROPRIATE BENEFITS.

V. COMPLETE THE SIGNATURES AND DATES SECTION.

VI. USE OF A SECOND DMA-5022

VII. SUBMIT THE DMA-5022 TO DATA ENTRY FOR KEYING.

VIII. OUTPUTS

EIS 2303 - CASEWORKER SUPERVISOR REPORT

I. GENERAL INFORMATION

II. THE REPORT IS SORTED BY:

III. THE REPORT LISTS ACTIONS YOU COMPLETED DURING THE PREVIOUS MONTH. THE ACTIONS WHICH ARE REPORTED ARE:

IV. IF YOU COMPLETE ONE OF THE ABOVE ACTIONS, THE FOLLOWING INFORMATION IS REPORTED ON THE CASEWORKER SUPERVISOR REPORT:

V. CHANGES KEYED IN STATE OFFICE

VI. USE THE COMMENTS SECTION OF THE CASEWORKER SUPERVISOR REPORT TO ENTER ANY NECESSARY DOCUMENTATION.

VII. CASEWORKER SUPERVISOR SUMMARY

EIS 2304 - NOTICE REGISTER REPORT

I. GENERAL INFORMATION

II. THE REPORT IS SORTED BY:

III. THE FOLLOWING INFORMATION IS LISTED ON THE REPORT:

IV. THE NOTICE REGISTER REPORT IS AVAILABLE FOR INQUIRY AND PRINTING IN THE X/PTR REPORT DISTRIBUTION SYSTEM.

EIS 2305 – ADULT MAIL-IN APPLICATION REPORTS

I. ADULT MAIL-IN APPLICATIONS TRACKING REPORT

II. ADULT MAIL-IN APPLICATIONS DENIED

EIS 2400 - APPLICATION PROCESSING TABLE OF CONTENTS

EIS 2400 – DSS-8124 APPLICATION SCREEN AND DSS-8124I

I. DSS-8124 APPLICATION SCREEN AND DSS-8124I

EIS 2400 – DSS-8124 APPLICATION ERRORS

II. DSS-8124 APPLICATION ERRORS

III. EIS 8124 DATE SCREEN

III.A. (CONT’d)

EIS 2400 – DISABILITY DETERMINTAION SECTION (DDS) DATA

IV. DISABILITY DETERMINATION SECTION (DDS) DATA

EIS 2400 – BENEFIT ISSUANCE FOR REOPENED APPLICATIONS

V. BENEFIT ISSUANCE FOR REOPENED APPLICATIONS (APPLICATIONS WITH DATE SCREENS)

EIS 2400 – DISPOSITION DATE

VI. DISPOSITION DATE

EIS 2400 – APPLICATION PROCESSING REPORTS

VII. APPLICATION PROCESSING REPORTS

EIS 2500 – PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (pace) Table of Contents

EIS 2500 – PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE)

I. INTRODUCTION

II. PACE POLICY

III. PACE AUTHORIZATION

IV. PACE AUTHORIZATION SCREEN INSTRUCTIONS ENTRY VIA THE DSS-8125

V. PACE END DATE SCREEN INSTRUCTIONS

VI. PACE/MANAGED CARE HISTORY INQUIRY

VII. PACE PROVIDER DATA INQUIRY

VIII. CASE DATA INQUIRY

IX. INDIVIDUAL AND MEDICAID ELIGIBILITY HISTORY INQUIRY

X. COUNTY TRANSFERS

xI. ID CARDS FOR PACE RECIPIENTS

XiI. PACE NOTICES/CODES

XIiI. PACE COUNTIES AND PROVIDERS

XIV. PACE PATIENT MONTHLY LIABILITY (PML)

XV. PACE CORRECTIONS

REISSUED 08/01/11 – CHANGE NO. 01-12

XVI. PACE REPORTS

EIS 2600 – HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD)

I. INTRODUCTION

II. HCWD Policy

III. COMPLETING THE DSS-8125

IV. HCWD INQUIRY

EIS 3000 - BENEFIT ISSUANCE FOR ACTIVE CASES

I. GENERAL INFORMATION

II. Medicaid Benefit Issuance

III. Medicaid Card Reports

EIS 3051 – REDETERMINING ELIGIBILITY FOR MEDICAID ONLY PROGRAMS

I. GENERAL INFORMATION

II. CASE MANAGEMENT REPORT

III. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

IV. COMPLETING THE REDETERMINATION

V. DO NOT ENTER THE FOLLOWING INFORMATION ON THE DSS-8125 FOR REDETERMINATIONS.

VI. COMPLETE THE SIGNATURES AND DATE SECTION

VII. KEY THE DSS-8125.

VIII. OUTPUTS

IX. AUTOMATED NOTICES

EIS 3052 – REDETERMINING ELIGIBILITY FOR REFUGEE AND SPECIAL ASSISTANCE

I. GENERAL INFORMATION

II. CASE MANAGEMENT REPORT

III. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

IV. COMPLETING THE REDETERMINATION

V. DO NOT ENTER THE FOLLOWING INFORMATION ON THE DSS-8125 (AND 8126) FOR REDETERMINATIONS.

VI. COMPLETE THE SIGNATURES AND DATE SECTION.

VII. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

VIII. OUTPUTS

IX. AUTOMATED NOTICES

EIS 3100 - MAKING CHANGES TO CASES

TABLE OF CONTENTS

I. GENERAL INSTRUCTIONS

II. UPDATING MEDICAID EFFECTIVE DATE

III. UPDATING PAYMENT EFFECTIVE DATE

IV. REMOVAL OF INFORMATION

V. UPDATING INFORMATION FOR A TIMELY NOTICE

EIS 3101 – CHANGES TO MEDICAID CASES

CHANGE OF ADDRESS

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGE NOT LISTED, SEE ”OTHER CHANGED DATA”

CHANGE IN LIVING ARRANGEMENT INCLUDING SUSPENSION

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES

CHANGE IN MEDICAID CLASSIFICATION

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES

PAYEE NAME CHANGES AND CHANGES OF PAYEE

I. GENERAL INFORMATION

II. UPDATING THE NAME OF THE CASEHEAD/PAYEE

III. CHANGE OF PAYEE

IV. PAYEE DESIGNATION FOR MAF/MIC CASES THAT EXISTED PRIOR TO 7/1/96

V. COMPLETING THE DSS-8125

VI. SIGNATURES AND DATE-IF USING A PAPER FORM

VII. KEY THE DSS-8125.

VIII. OUTPUTS

IX. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

DEDUCTIBLE TO AUTHORIZED

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES (DEDUCTIBLE TO AUTHORIZED)

DELETION OF AN INDIVIDUAL

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES (DELETION OF INDIVIDUAL)

AUTHORIZED TO DEDUCTIBLE INCLUDING INCOME CHANGE

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

VI. AUTOMATED NOTICES

SPECIAL COVERAGE GROUPS - COMMUNITY ALTERNATIVE PROGRAM

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. KEY THE DSS-8125.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”

CHANGE TO A TERMINATED CASE

I. THE FOLLOWING INFORMATION CAN BE CORRECTED ON A CASE THAT IS ALREADY TERMINATED IN EIS.

II. COMPLETING THE DSS-8125

II. THESE ACTIONS APPEAR ON THE CASEWORKER SUPERVISOR REPORT UNDER THE HEADING "MAIN/TERM." THE NUMBER OF ACTIONS COMPLETED IS DETERMINED FROM THE WORKER NUMBER.

CHANGE IN MEDICARE STATUS

I. Medicare D NOTICE OF ACTION Generated from mma file information OR SDX UPDATE

II. ADEQUATE ACTION NOTICES (DSS-8110 or MMA file notice)

OTHER CHANGED DATA

I. USE THE DSS-8125 TO COMPLETE ANY CHANGES TO AN ACTIVE MEDICAID CASE. THE FIELDS LISTED BELOW ARE REQUIRED ENTRIES FOR ANY CHANGE. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

II. THE FOLLOWING FIELDS MAY BE CHANGED OR UPDATED AS NEEDED UNLESS OTHERWISE INDICATED. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

III. SIGNATURES AND DATE

IV. KEY THE DSS-8125.

V. OUTPUTS

VI. AUTOMATED NOTICES

EIS 3102 – CHANGES TO R-RF AND SA CASES

CHANGE OF ADDRESS

I. COMPLETING THE ADDRESS

II. SIGNATURES AND DATE

III. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

IV. OUTPUTS:

V. FOR ANY CHANGE NOT LISTED, SEE "OTHER CHANGED DATA."

PAYEE NAME CHANGES AND CHANGES OF PAYEE

I. GENERAL INFORMATION

II. UPDATING THE NAME OF THE CASEHEAD/PAYEE

III. CHANGE OF PAYEE

IV. COMPLETING THE DSS-8125

V. SIGNATURES AND DATE

VI. KEY THE DSS-8125.

VII. OUTPUTS

VIII. for any changes not listed, see “other changed data.”

DELETION OF AN INDIVIDUAL

I. COMPLETE AN AUTOMATED BUDGET CALCULATION FOR THE AFFECTED PAYMENT MONTH WHEN DELETING AN INDIVIDUAL FROM A R-RF CASE. COMPLETE THE BUDGET BEFORE SUBMITTING THE DSS-8125 TO DATA ENTRY.

II. COMPLETING THE DSS-8125

III. SIGNATURES AND DATE

IV. KEY THE DSS-8125.

V. OUTPUTS

VI. FOR ANY CHANGES NOT LISTED, SEE "OTHER CHANGED DATA."

VII. AUTOMATED NOTICES

GRANT RECOUPMENT

I. COMPLETE AN AUTOMATED BUDGET CALCULATION FOR THE AFFECTED PAYMENT MONTH WHEN ENTERING A GRANT RECOUPMENT FOR A R-RF CASE. COMPLETE THE BUDGET BEFORE SUBMITTING THE DSS-8125 TO DATA ENTRY.

II. COMPLETING THE DSS-8125

III. SIGNATURES AND DATE

IV. Key THE DSS-8125.

V. OUTPUTS

VI. FOR ANY CHANGES NOT LISTED, SEE "OTHER CHANGED DATA."

VII. AUTOMATED NOTICES

PAYMENT REVISION

I. COMPLETE AN AUTOMATED BUDGET CALCULATION FOR THE AFFECTED PAYMENT MONTH WHEN ENTERING A PAYMENT REVISION FOR A R-RF CASE. COMPLETE THE BUDGET BEFORE SUBMITTING THE DSS-8125 TO DATA ENTRY.

II. COMPLETING THE DSS-8125

III. SIGNATURES AND DATE

IV. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

V. OUTPUTS

VI. FOR ANY CHANGES NOT LISTED, SEE "OTHER CHANGED DATA."

VII. AUTOMATED NOTICES

SPECICAL COVERAGE – COMMUNITY ALTERNATIVE PROGRAM (CAP)

I. USE THE DSS-8125, ELIGIBILITY INFORMATION SYSTEM DATA SHEET, TO ENTER CAP SPECIAL COVERAGE DATA INTO EIS IN THE FOLLOWING SITUATIONS:

II. USE THE FOLLOWING INSTRUCTIONS TO ENTER CAP INFORMATION FOR ANY OF THE SITUATIONS LISTED IN I. ABOVE.

III. SIGNATURES AND DATE.

IV. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

V. OUTPUTS

SPECIAL COVERAGE - SPECIAL ASSISTANCE HIGHER LEVEL OF CARE

I. USE THE DSS-8125, ELIGIBILITY INFORMATION SYSTEM DATA SHEET, TO ENTER SPECIAL ASSISTANCE HIGHER LEVEL OF CARE SPECIAL COVERAGE DATA INTO EIS IN THE FOLLOWING SITUATIONS:

II. USE THE FOLLOWING INSTRUCTIONS TO ENTER HIGHER LEVEL OF CARE INFORMATION FOR EITHER OF THE SITUATIONS LISTED IN I. ABOVE.

III. SIGNATURES AND DATE.

IV. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

V. OUTPUTS

VI. FOR ANY CHANGES NOT LISTED, SEE "OTHER CHANGED DATA.

SUBSTITUTE PAYEE

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE "OTHER CHANGED DATA.

CONTINUATION CASES

I. COMPLETING THE DSS-8125

II. SIGNATURES AND DATE

III. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

IV. OUTPUTS

V. FOR ANY CHANGES NOT LISTED, SEE "OTHER CHANGED DATA".

VI. EIS AUTOMATICALLY TRANSFERS CONTINUATION CASES TO MAF-C THE 6th WORKNIGHT from the end of the FOURTH MONTH IF THE IMC HAS NOT COMPLETED A REVIEW AND TRANSFERRED THE CASE TO ONGOING COVERAGE OR TERMINATED THE CASE. A CASE PROFILE IS PRODUCED THE NIGHT THE TRANSFER PROCESSES AND IS MAILED TO THE COUNTY THE FOLLOWING WORKDAY.

CHANGE TO A TERMINATED CASE

I. The following information can be corrected on a case that is already terminated in EIS.

II. COMPLETING THE DSS-8125

III. THESE ACTIONS APPEAR ON THE CASEWORKER SUPERVISOR REPORT UNDER THE HEADING "MAIN/TERM." THE NUMBER OF ACTIONS COMPLETED IS DETERMINED FROM THE WORKER NUMBER.

CHANGE IN STEPPARENT INDICATOR

I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. SIGNATURES AND DATE

IV. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

V. OUTPUTS

OTHER CHANGED DATA

I. USE THE DSS-8125 TO COMPLETE ANY CHANGES TO REFUGEE OR SPECIAL ASSISTANCE CASES. THE FIELDS LISTED BELOW ARE REQUIRED ENTRIES FOR ANY CHANGE:

II. THE FOLLOWING FIELDS MAY BE CHANGED OR UPDATED AS NEEDED UNLESS OTHERWISE INDICATED. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

III. SIGNATURES AND DATE

IV. Key THE DSS-8125.

V. OUTPUTS

EIS 3104 - DMA-5022 INSTRUCTIONS FOR MAKING CHANGES TO SPECIAL ASSISTANCE CASES

I. GENERAL INSTRUCTIONS

II. COMPLETE SECTION A OF THE DMA-5022 TO REQUEST EITHER PAYMENT LISTED IN I. ABOVE. FOLLOW THE INSTRUCTIONS BELOW. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

III. COMPLETE SECTION C OF THE DMA-5022 TO REQUEST A STATE ISSUED ADJUSTED PAYMENT OR PRIOR MONTH PAYMENT. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

IV. COMPLETE THE SIGNATURES AND DATES SECTION.

V. SUBMIT THE DMA-5022 TO DATA ENTRY FOR KEYING.

VI. OUTPUTS

EIS 3105 - DEDUCTIBLE BALANCE/PATIENT MONTHLY LIABILITY TRANSACTION

I. GENERAL INFORMATION

II. USE THIS TRANSACTION TO:

III. APPLICATION DISPOSITION

IV. Authorizing Retroactive Medicaid Benefits Up to Three Months Prior to the Month of Application

V. ESTABLISHED CASES

VI. requesting a replacement medicaid id card

EIS 3151 - REQUESTING A MEDICAID ID CARD

I. GENERAL INFORMATION

EIS 3152 REQUESTING REPLACEMENT CHECKS

I. GENERAL INFORMATION

II. THE DSS-8129 SERVES AS:

III. INSTRUCTIONS FOR COMPLETION OF THE DSS-8129

IV. COMPLETE THE SIGNATURE AND DATES SECTION.

V. SUBMIT THE DSS-8129 AS SOON AS POSSIBLE.

EIS 3200 - TERMINATING A CASE

I. GENERAL INFORMATION

II. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

III. ENTER THE FOLLOWING REQUIRED INFORMATION ON THE DSS-8125 TO TERMINATE A CASE. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

IV. SYSTEM GENERATED TERMINATIONS

V. SYSTEM GENERATED ACTIONS

VI. INFORMATION THAT IS DELETED

VII. INFORMATION YOU MAY UPDATE

VIII. INFORMATION YOU MAY NOT CHANGE OR UPDATE

IX. BENEFITS ISSUANCE

X. OUTPUTS

XI. AUTOMATED NOTICES FOR WORKER INITIATED TERMINATIONS

XII. AUTOMATED NOTICES FOR EIS INITIATED TERMINATIONS

EIS 3210 - MQB-E AUTOMATED RE-ENROLLMENT PROCESS

I. GENERAL INFORMATION

II. RE-ENROLLMENT PROCESS

III. TERMINATIONS

EIS 3250 - PROCESSING CASH OVERPAYMENT COLLECTIONS

I. GENERAL INFORMATION

II. DISTRIBUTE THE COPIES OF THE DSS-1656 AS FOLLOWS:

EIS 3300 - RESOLVING DUPLICATE IDS

I. GENERAL INFORMATION

II. STATE GENERATED DSS-8128’S

III. COUNTY INITIATED DSS-8128’S

IV. ERRORS AND UPDATES FROM 8128 UPDATE REPORT

EIS 3350 – THIRD PARTY HEALTH AND ACCIDENT RESOURCES INFORMATION (DMA-2041)

I. GENERAL INFORMATION

I. GENERAL INFORMATION (cont’d)

II. Entering TPR Data in EIS

II. Entering TPR Data in EIS (cont’d)

II. Entering TPR Data in EIS (cont’d)

III. POLICY UPDATE

III. POLICY UPDATE (cont’d)

IV. INDIVIDUAL UPDATE

IV. INDIVIDUAL UPDATE (cont’d)

IV. INDIVIDUAL UPDATE (cont’d)

IV. INDIVIDUAL UPDATE (cont’d)

IV. INDIVIDUAL UPDATE (cont’d)

V. third party insurance REPORTING for nchc and bccm

V. third party insurance REPORTING for nchc and bccm (cont’d)

GLOSSARY OF TERMS

EIS 3400 - ERROR REPORTING

I. GENERAL INFORMATION

II. COMMON EDIT ERRORS

III. PROGRAM SPECIFIC EDIT ERRORS

IV. CORRECTING ERRORS

V. DSS-8125/8126 INQUIRY

EIS 3402 - ERROR AND ATTENTION REPORT

I. THE ELIGIBILITY INFORMATION SYSTEM (EIS) PRODUCES AN ERROR AND ATTENTION REPORT NIGHTLY.

II. THIS IS A LIST OF THE ERROR MESSAGES WHICH MIGHT APPEAR ON THE ERROR AND ATTENTION REPORT FOR THE DSS-8124 OR DSS-8125.

III. ANOTHER FUNCTION OF THE ERROR AND ATTENTION REPORT IS TO ASSIST INCOME MAINTENANCE CASEWORKERS AND DATA ENTRY OPERATORS IN TRACKING work first, MEDICAID, AND SA ACTIONS THAT ARE ON HOLD PENDING A TEN DAY TIMELY NOTICE PERIOD.

EIS 3450 - GENERAL INSTRUCTIONS FOR AID PROGRAM/CATEGORY TRANSFERS

I. CHANGING THE AID PROGRAM/CATEGORY OF A CASE IS ACCOMPLISHED THROUGH REAPPLICATION OR AN ALLOWABLE TRANSFER.

II. USE THE FOLLOWING CHART TO DETERMINE IF THE AID PROGRAM/CATEGORY CHANGE YOU WISH TO PERFORM IS AN ALLOWABLE TRANSFER.

III. IF THE AID PROGRAM/CATEGORY CHANGE IS NOT AN ALLOWABLE TRANSFER, FOLLOW THE INSTRUCTIONS IN COMPLETING AN APPLICATION FORM, EIS 2010.

III. IF THE AID PROGRAM/CATEGORY CHANGE IS AN ALLOWABLE TRANSFER, AND THE CASE IS TRANSFERRING TO A MEDICAID PROGRAM, TURN TO TRANSFERS TO MEDICAID PROGRAMS, EIS 3451.

IV.

Individual who becomes INCARCERATED OR PLACED IN An INSTITUTION FOR mENTAL DISEASE (IMD):

EIS 3451 – AID PROGRAM/CATEGORY TRANSFERS TO MEDICAID PROGRAMS

I. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

II. FIND THE AID PROGRAM/CATEGORY TRANSFER YOU WISH TO PERFORM IN THE FOLLOWING TABLE OF CONTENTS. THEN, TURN TO THE REFERENCED PAGE NUMBER FOR INSTRUCTIONS.

TRANSFERRING FROM M-AA OR M-AD TO M-AB

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

(TRANSFERRING FROM M-QB TO M-AA, M-AD, OR M-AB)

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

(TRANSFERRING FROM M-AA, M-AB, OR M-AD TO M-QB)

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

REISSUED 02/01/11 – CHANGE NO. 03-11

TRANSFERRING FROM M-AB TO M-AD OR M-AA)

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM M-AD TO M-AA

I. AUTOMATED TRANSFER

II. MANUAL TRANSFER

III. KEY THE DSS-8125.

IV. OUTPUTS

TRANSFERRING FROM M-AA TO M-AD

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM M-AF TO M-PW

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM M-AF to M-IC

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM M-PW TO M-AF

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM M-IC TO M-AF

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM A-AF TO M-AF

I. AUTOMATED TRANSFERS

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES

TRANSFERRING FROM A-AF TO M-IC

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM A-AF TO M-PW

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

IV. AUTOMATED NOTICES

TRANSFERRING FROM R-RF TO M-RF

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

TRANSFERRING FROM S-AD OR S-AA TO M-AA, M-AB, OR M-AD

I. COMPLETING THE DSS-8125

II. KEY THE DSS-8125.

III. OUTPUTS

TRANSFERRING FROM A-AF OR M-AF TO TRANSITIONAL MEDICAID

I. TRANSFERS TO TRANSITIONAL Medicaid

II. COMPLETING THE DSS-8125 (Transfers to transitional Medicaid)

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES

EIS 3452 – AID PROGRAM/CATEGORY TRANSFERS TO SPECIAL ASSISTANCE PROGRAMS

I. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

II. FIND THE AID PROGRAM/CATEGORY TRANSFER YOU WISH TO PERFORM IN THE FOLLOWING TABLE OF CONTENTS. THEN, TURN TO THE REFERENCED PAGE NUMBER FOR INSTRUCTIONS.

TRANSFERRING FROM S-AA TO S-AD

I. COMPLETING THE DSS-8125

II. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

III. OUTPUTS

TRANSFERRING FROM S-AD TO S-AA

I. AUTOMATED TRANSFER

II. MANUAL TRANSFER

III. COMPLETING THE DSS-8125

IV. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

V. OUTPUTS

TRANSFERRING FROM S-AA OR S-AD TO S-CD

I. COMPLETING THE DSS-8125

II. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

III. OUTPUTS

TRANSFERRING FROM S-CD TO S-AA

I. COMPLETING THE DSS-8125

II. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

III. OUTPUTS

TRANSFERRING FROM S-CD TO S-AD

I. COMPLETING THE DSS-8125

II. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

III. OUTPUTS

EIS 3500 – COUNTY TRANSFERS FOR ACTIVE CASES

I. GENERAL INFORMATION

II. ACTIONS THAT REQUIRE A SEPARATE DSS-8125

III. COMPLETING THE COUNTY TRANSFER

IV. SUBMIT THE DSS-8125 TO DATA ENTRY. A COUNTY TRANSFER MAY BE KEYED THROUGH THE LAST WORKING DAY OF THE MONTH.

V. OUTPUTS

EIS 3510 – FAMILY PLANNING WAIVER – CAPPED ENROLLMENT

I. INTRODUCTION

II. family planning enrollment management report

III. FAMILY PLANNING WAIVER CAPPED ENROLLMENT DENIALS REPORT

IV. FAMILY PLANNING WAIVER APPLICATIONS REACTIVATED

V. family planning waiver outcome of reactivation

EIS 3520 – MEDICARE ENTITLEMENT AND ENROLLMENT

I. INTRODUCTION

II. AUTOMATED NOTICE CHANGES FOR MEDICAID PROGRAMS

EIS 3551 – CASE MANAGEMENT REPORT

I. GENERAL INFORMATION

II. FORMAT – case management

III. CASES DUE FOR REVIEW – case management report

IV. CASES OVERDUE – case management report

V. SPECIAL MESSAGES – case management report

EIS 3552 – POSSIBLE DUPLICATE ID REPORTS

EIS 3553 – PENDING COUNTY REASSIGNMENT REPORT

I. GENERAL INFORMATION

II. THE INFORMATION DISPLAYED ON THE PENDING COUNTY REASSIGNMENT REPORT INCLUDES:

EIS 3564 – HEALTH COVERAGE FOR WORKERS WITH DISABILITIES REPORTS

(Suspended 12/01/2009)

I. HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD) enrollment FEE RECONCILIATION REPORT

II. HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD) DETAILED ENROLLMENT FEE RECONCILIATION REPORT FOR APPROVALS

EIS 3555 – CASE PROFILE

I. GENERAL INFORMATION

II. COUNTY CHANGES

III. STATE CHANGES

IV. OTHER CHANGES

V. REVIEWING THE CASE PROFILE

EIS 3556 – NOTICE REGISTER REPORT

I. GENERAL INFORMATION

II. THE REPORT IS SORTED BY:

III. THE FOLLOWING INFORMATION IS LISTED ON THE REPORT:

IV. THE NOTICE REGISTER REPORT IS AVAILABLE FOR INQUIRY AND PRINTING IN THE X/PTR REPORT DISTRIBUTION SYSTEM. THE LAST SIX REPORTS ARE RETAINED IN XPTR FOR 3660 DAYS.

EIS 3557 – MIC RE-ENROLL REPORTS 1 AND 2

I. RE-ENROLLMENT MIC REPORT SUMMARY 1

II. RE-ENROLLMENT REPORT SUMMARY 2

EIS 3558 – RECIPIENTS IN NON-MEDICAL INSTITUTIONS REPORTS

I. GENERAL INFORMATION

II. THE FOLLOWING CODES display on the report:

III. THE REPORT IS SORTED BY county:

IV. THE FOLLOWING INFORMATION is listed on the report:

V. X/PTR REPORT DISTRIBUTION SYSTEM

EIS 3559 – AGE 65 LETTERS/REPORTS

I. GENERAL INFORMATION

II. AGE 65 NOTICE REGISTER

III. OVER 65 INDIVIDUALS WITH NO RSDI#

EIS 3561 – TRANSITIONAL NOTICE REGISTER

I. GENERAL INFORMATION

II. THE STATE PRINTED REGISTER IS SORTED BY:

III. THE FOLLOWING INFORMATION IS LISTED ON THE STATE PRINTED REGISTER:

IV. DESTROY THE REGISTER AFTER THREE YEARS OR WHEN RELEASED FROM ALL AUDITS, WHICHEVER OCCURS LATER.

V. X/PTR - REPORT DISTRIBUTION SYSTEM

EIS 3562 – TRANSITIONAL CASES DUE REVIEW REPORT

I. GENERAL INFORMATION

II. THE Report IS SORTED BY:

III. CASES DUE FOR REVIEW

IV. SPECIAL MESSAGES

V. X/PTR - Report Distribution system

EIS 3563 – AAF AUTOMATIC TRANSFERS TO MAF 24/60 MONTH, WORK FIRST BENEFITS, SANCTION AND BENEFIT DIVERSION CASES TIME LIMITS HAVE BEEN REACHED

I. GENERAL INFORMATION

II. THE REPORT IS SORTED BY:

III. THE FOLLOWING INFORMATION IS LISTED ON THE REPORT:

EIS 3564 – HEALTH COVERAGE FOR WORKERS WITH DISABILITIES REPORTS

(Suspended 12/01/2009)

I. HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD) enrollment FEE RECONCILIATION REPORT

II. HEALTH COVERAGE FOR WORKERS WITH DISABILITIES (HCWD) DETAILED ENROLLMENT FEE RECONCILIATION REPORT FOR APPROVALS

EIS 3600 – WORK FIRST/TRANSITIONAL QUARTERLY REPORTING

I. GENERAL INFORMATION

II. WORK FIRST/TRANSITIONAL quarterly REPORTING CASE SELECTION

III. THE SELECTION CYCLE

IV. Work First/TRANSITIONAL quarterly REPORTING SCREENS

V. WORK FIRST QUARTERLY REPORTING REGISTER

WORK FIRST/TRANSITIONAL QUARTERLY REPORTING – PART TWO

I. GENERAL INFORMATION

II. LOGON PROCEDURES

III. VIEWING AND/OR UPDATING THE Quarterly REPORTING DATABASE

IV. MOVING TO OTHER IMS FUNCTIONS

V. LOGOFF PROCEDURES

WORK FIRST/TRANSITIONAL QUARTERLY REPORTING – PART THREE

I. GENERAL INFORMATION

II. Work First/TRANSITIONAL quarterly REPORTING SCREEN UPDATE

III. Work First/TRANSITIONAL SECOND quarterly REPORTS

IV. WORK FIRST QUARTERLY/Transitional REPORTING REGISTER

WORK FIRST/TRANSITIONAL QUARTERLY REPORTING – PART FOUR

I. GENERAL INFORMATION

II. Work First/TRANSITIONAL Quarterly REPORTING SCREEN UPDATE

III. Work First/TRANSITIONAL CASE TRANSFERS

IV. WORK FIRST/Transitional QUARTERLY REPORTING REGISTER

V. OTHER NOTICE ACTIVITY

EIS 3700 – JOB BONUS TRACKING SCREEN

I. GENERAL INFORMATION

II. ACCESS PROCEDURES

III. PROCEDURES FOR KEYING

IV. EDITS

V. MOVING TO OTHER IMS FUNCTIONS

VI. LOGOFF PROCEDURES

EIS 3800 – TRANSITIONAL BENEFITS REPORTS TRACKING

I. TRANSITIONAL BENEFIT REPORTING

II. TRANSITIONAL BENEFITS REPORTS TRACKING

III. UPDATING THE TRANSITIONAL BENEFITS REPORTS TRACKING SCREEN

IV. EIS REVIEWS THE TBR TRACKING SCREEN - FIRST QR DEADLINE

V. EIS REVIEWS THE TBR TRACKING SCREEN - SECOND QR DEADLINE

EIS 3900 – ASSETS TRANSFER TRACKING SCREEN

I. General information

II. PROCESS

III. PROCEDURES FOR KEYING

IV. LOGOFF PROCEDURES

V. COMBINING INDIVIDUAL ID NUMBERS

VI. 8128 ASSETS TRANSFER Discrepancy Report

VII. TRANSFER OF ASSETS – individuals with sanction Report

EIS 4000 CODES APPENDIX TABLE OF CONTENTS

I. DSS-8124/8125/8126 CODES

II. DMA-2041 CODES

III. DMA-5022 CODES

I. DSS-8124/8125/8126 CODES

II. DMA-2041 CODES

III. DMA-5022 CODES

EIS 4000 – CODES APPENDIX A – WORK FIRST CODES

WORK FIRST CODES

EIS 4000 – CODES APPENDIX B – MEDICAID CODES

CHANGE CODES - MEDICAID CHANGES

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS FOR NON-SSI CASES WITH A CERT. THROUGH DATE OF 12/31/9999.

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS FOR NON-SSI CASES WITH A CERT. THROUGH DATE OF 12/31/9999 (CONT’D)

DISPOSITION CODES - MEDICAL ASSISTANCE APPROVALS

DISPOSITION CODES - MEDICAL ASSISTANCE DENIALS(G8 IS THE ONLY DENIAL CODE FOR M-SB CASES.)

DISPOSITION CODES – MEDICAL ASSISTANCE WITHDRAWALS

MEDICAID TERMINATION CODES

TRANSFERS (AID PROGRAM/CATEGORY)

EIS 4000 - CODES APPENDIX C – REFUGEE ASSISTANCE

DISPOSITION CODES - REFUGEE ASSISTANCE APPROVALS

DISPOSITION CODES - REFUGEE DENIALS

DISPOSITION CODES - REFUGEE ASSISTANCE WITHDRAWALS

TERMINATION CODES - REFUGEE TERMINATIONS

EIS 4000 - CODES APPENDIX D – SPECIAL ASSISTANCE CODES

EIS 4000 – CODES APPENDIX E – TRANSITIONAL CODES

CHANGE CODES - TRANSITIONAL BENEFIT CHANGES

TERMINATION CODES - TRANSITIONAL BENEFIT TERMINATIONS

TRANSFER CODES - TRANSITIONAL BENEFIT TRANSFERS TO MEDICAID

CASEWORKER INITIATED TRANSFERS

eis automated TRANSFERS

EIS 4050 - MAILING ADDRESS APPENDIX

I. introduction

II. addressing software

iii. improving address quality

IV. 911 Addresses

V. Mailing Address for SSI Medicaid Recipients

VI. Resources

VII. COMMON ABBREVIATIONS

VIII. CITY ABBREVIATIONS

IX. STATE ABBREVIATIONS

EIS 4100–Community Care of North Carolina/CAROLINA ACCESS

I. GENERAL INFORMATION

II. Enrollment IN CCNC/CA

III. CHANGES TO ENROLLMENT

IV. Entering CA Data in EIS

EIS 4200 – SSI MEDICAID-INTRODUCTION
PART ONE

I. STATE DATA EXCHANGE (SDX)

II. MATCH PROCESS

III. EMERGENCY MEDICAID

IV. EXCEPTIONS TO AUTOMATIC MEDICAID ELIGIBILITY-REFUSAL TO PROVIDE TPR

EIS 4200 – SSI MEDICAID-EXCEPTION PROCESSING
PART TWO

I. GENERAL INFORMATION

II. ACCESSING THE SDX EXCEPTION LIST

III. RESOLVING THE EXCEPTIONS

EIS 4200 – SSI MEDICAID-APPROVAL/DENIAL
PART THREE

I. SSI MEDICAID APPROVAL

II. SSI DENIAL/MEDICAID DENIAL

EIS 4200 – SSI MEDICAID-OPEN/SHUT APPROVAL
PART FOUR

I SSI MEDICAID CASE CREATION

II. BENEFIT ISSUANCE

III. AUTOMATED NOTICES

IV. RETROACTIVE MEDICAID

EIS 4200 – SSI MEDICAID-CHANGING AN SSI MEDICAID CASE
PART FIVE

I. SDX CONTROLLED DATA

II. COUNTY/SDX CONTROLLED DATA

III. SDX CHANGES

IV. ALLOWABLE COUNTY CHANGES

V. INSTRUCTIONS FOR ALLOWABLE CHANGES

EIS 4200 – SSI MEDICAID-TERMINATIONS
PART SIX

I. SAA, SAD, and AAF (PAYMENT TYPE 5)

II. MAABD AND HSF - SSI TERMINATION DUE TO DEATH OR MOVING OUT OF STATE

III. MAABD & HSF-OTHER TERMINATIONS OF SSI

IV. EX PARTE ACTIONS

V. SSI IS REAPPROVED.

VI. RETROACTIVE TERMINATION OF SSI

EIS 4200 – SSI MEDICAID-APPLICATIONS
PART SEVEN

I. MAABD-RETROACTIVE TO SSI MONTH OF APPLICATION

II. FAMILY AND CHILDREN MEDICAID RETROACTIVE TO SSI MONTH OF APPLICATION

III. REAPPLICATION WHEN SSI TERMINATES

EIS 4200 – SSI MEDICAID-REPORTS
PART EIGHT

I. SSI MEDICAID CASES CREATED/MODIFIED BY EIS

II. SSI INDIVIDUAL IN EIS PENDING APPLICATION

III. SSI/MEDICAID ID REGISTERS

IV. SSI APPROVAL-MEDICAID DENIED (TPR REFUSAL)

V. TPR REFUSAL-MEDICAID TERMINATED

VI. TPR REFUSAL-SSI INDIV RECEIVING SAA/SAD/HSF

VII. SSI TERMINATED-SSI INDIV PREVIOUSLY RECEIVED AFDC

VIII. SSI EXEMPT

IX. SSI TERMINATION REPORT

X. SSI TERMINATION ALERT REPORT

XI. ssi/sdx exceptions error report

EIS 4300 - NC HEALTH CHOICE – INTRODUCTION PART ONE

INTRODUCTION

EIS 4300 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS, REAPPLICATIONS, AND ADD-AN-INDIVIDUAL APPLICATIONS FOR NC HEALTH CHOICE – PART TWO

I. GENERAL INFORMATION

II. NAME SEARCH AND INDIVIDUAL ID ASSIGNMENT

III. COMPLETING THE COMPUTER INPUT SCREEN IN EIS

EIS 4300 - MAKING CHANGES TO NC HEALTH CHOICE APPLICATIONS
PART THREE

I. GENERAL INFORMATION

II USE THE NAME CHANGE FUNCTION OR THE DSS-8124 SCREEN TO MAKE CHANGES TO PENDING APPLICATIONS.

III. THE FOLLOWING INFORMATION MAY NOT BE CHANGED ON AN APPLICATION THAT HAS BEEN ENTERED AND ACCEPTED INTO THE SYSTEM:

IV. OUTPUT

EIS 4300 - NC HEALTH CHOICE APPLICATION DISPOSITIONS – PART FOUR

I. DENYING AN APPLICATION

II. WITHDRAWING AN APPLICATION

III. APPROVING THE APPLICATION

IV. ADD-ON APPLICATION APPROVALS

EIS 4300 - NC HEALTH CHOICE – ONGOING CASE MAINTENANCE
PART FIVE

I. CHANGE IN INCOME

II. CHANGE OF ADDRESS

III. TRANSFER TO ANOTHER COUNTY

IV. PROGRAM TRANSFER

V. CHANGE IN HOUSEHOLD COMPOSITION

VI. REENROLLMENT IN NC HEALTH CHOICE

VII. OPTIONAL EXTENDED COVERAGE

VIII. CHANGES TO NC HEALTH CHOICE CASES WHICH MAY RESULT IN DELETION/TERMINATION

VIII. (CONT’D)

IX. INDIVIDUALS PLACED IN LONG TERM CARE/ICF-MR

IX. (CONT’D)

X. INDIVIDUAL BECOMES PREGNANT

XI. SOCIAL SECURITY NUMBER CHANGES OR SSN IS ADDED TO THE CASE

XII. INCORRECT EFFECTIVE DATE FOUND AFTER APPROVAL

XIII. CHANGE MEDICAID CLASSIFICATION TO/FROM “J” “K” “S” or “A” (includes changes from j, k, s, or A to mic-n, MIC-1, or maf)

EIS 4300 – NC HEALTH CHOICE – NOTICES AND CODES
PART SIX

I. NC HEALTH CHOICE DISPOSITION CODES

II. NC HEALTH CHOICE CHANGE CODES

III. NC HEALTH CHOICE TRANSFER CODES

IV. NC HEALTH CHOICE TERMINATION CODES

V. APPLICATION DISPOSITION CODES

VI. REDETERMINATION

Vii. CHANGE CODES

ViII. TRANSFER CHANGE CODES

IX. CASE TERMINATION CODES

EIS 4300 – NC HEALTH CHOICE – REPORTS
PART SEVEN

I. NC HEALTH CHOICE CASEWORKER/SUPERVISOR REPORT

II. SUMMARY COUNTY WORKER TRANSACTIONS BY TITLE XIX VERSUS NC HEALTH CHOICE TRANSACTIONS DURING THE MONTH

III. NC HEALTH CHOICE PREMIUM RECONCILIATION REPORT FOR APPROVALS

IV. NC HEALTH CHOICE DETAILED PREMIUM RECONCILIATION REPORT FOR APPROVALS

V. NC HEALTH CHOICE AND MEDICAID APPLICATIONS TAKEN/APPROVED SINCE OCTOBER 1, 1998

VI. ELIGIBLES BY FAMILY SIZE, AGE, SEX, RACE, AND INCOME LEVEL

VII. NUMBER OF CHILDREN ENROLLED IN NC HEALTH CHOICE AND MEDICAID BY MONTH, FISCAL YEAR, AND YEAR-TO-DATE

VIII. NCHC AND family and CHILDREN’S MEDICAID APPROVED APPLICATIONS BY SOURCE

IX. NUMBER OF NC HEALTH CHOICE APPLICATIONS DENIED/WITHDRAWN

X. NC HEALTH CHOICE EXTENDED COVERAGE PARTICIPANTS (CLASS ‘L’)

XI. NC HEALTH CHOICE INDIVIDUALS WITH MEDICARE COVERAGE

XII. NC HEATH CHOICE RE-ENROLLMENT REPORT

XIII. RE-ENROLLMENT NCHC REPORT SUMMARY 1

XIV. RE-ENROLLMENT REPORT SUMMARY 2

XV. nc Health choice active recipients

XVI. NC HEALTH CHOICE LIMITED FUNDING

EIS 4900 – DATA ENTRY APPENDIX A - LOGON/LOGOFF PROCEDURES

I. LOGON PROCEDURES

II. LOGOFF PROCEDURES

EIS 4900 – DATA ENTRY APPENDIX B - DSS-8124 (KEYING AN APPLICATION)

I. GENERAL INFORMATION

II. ACCESS

III. KEYING AN APPLICATION

IV. ACCESSING EIS 8124'S PLACED ON HOLD

V. CHANGING/CORRECTING A PENDING APPLICATION

VI. DENIALS/WITHDRAWALS

EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART ONE

I. GENERAL INFORMATION

II. CONVERSION

III. IV-D ID ASSIGNMENT

IV. AP ID ASSIGNMEMT

V. REFERRALS TO IV-D

VI. UPDATES TO DATA IN EIS

VII. INFORMATION FROM IV-D/ACTS

VIII. UPDATES TO INFORMATION SENT TO IV-D

EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART TWO

I. REFERRALS AND UPDATES TO IV-D

II. GENERAL INSTRUCTIONS

III. REFERRAL QUESTION SCREENS

IV. REFERRAL SCREENS

V. ADD-ON APPLICATIONS

VI. REAPPLICATIONS, INCLUDING ADMINISTRATIVE ACTIONS

VII. SPIN-OFF APPLICATIONS

VIII. GOOD CAUSE CLAIM AT APPLICATION

EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART THREE

I. GENERAL INFORMATION

II. ADJ "UP" PPPA FUNDS-ADJUST UP PPPA (PAST PAID PUBLIC ASSISTANCE) FUNDS

III. KEY A REFERRAL

IV. INQUIRY INTO DATA SENT FROM ACTS

EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART FOUR

I. EIS CASEWORKER IV-D WORKLIST

II. THE REPORT IS SORTED BY:

III. THE FOLLOWING INFORMATION IS LISTED ON THE REPORT:

IV. REPORT MANAGEMENT AND DISTRIBUTION SYSTEM

EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART FIVE

EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART SIX

I. CASE/INDIVIDUAL IVD INDICATOR CHANGE REPORT

II. REPORT

EIS 4900 – DATA ENTRY APPENDIX D - DATE SCREEN

I. GENERAL INFORMATION

II. ACCESS

III. CHANGES

IV. DISPOSING OF APPLICATIONS WITH DATE SCREEN ERRORS

V. DELETIONS

EIS 4900 - DATA ENTRY – APPENDIX E - DSS-8125 (APPROVING AN APPLICATION)

I. GENERAL INFORMATION

II. ACCESS

III. KEYING INSTRUCTIONS

IV. ERROR AND ATTENTION REPORT

V. ACCESSING 8125 ACTIONS PLACED ON HOLD

VI. DELETING 8125 ACTIONS

VII. CASE PROFILES

VIII. FORMS PROCESSED REPORT

EIS 4900 – DATA ENTRY APPENDIX E - DSS-8125 (MAKING CHANGES TO A CASE)

I. GENERAL INFORMATION

II. ACCESS

III. KEYING INSTRUCTIONS - MAKING CHANGES TO A CASE

IV. ERROR AND ATTENTION REPORT

V. ACCESSING 8125 ACTIONS PLACED ON HOLD

VI. DELETING 8125 ACTIONS

VII. CASE PROFILES

VIII. FORMS PROCESSED REPORT

EIS 4900 – DATA ENTRY APPENDIX F - DMA-2041 (THIRD PARTY RECOVERY)

I. GENERAL INFORMATION

II. ACCESS

III. SCREENS

Iv. keyING INSTRUCTIONS

V. FORMS PROCESSED REPORT

EIS 4900 – DATA ENTRY APPENDIX G - DMA-5022

I. GENERAL INFORMATION

II. ACCESS

III. KEYING THE DMA-5022

IV. TURNAROUND

V. PF KEYS

VI. ERROR MESSAGES

EIS 4900 – DATA ENTRY APPENDIX H - DSS-8128

I. GENERAL INFORMATION

II. ACCESS

III. KEYING THE DSS-8128

IV. 8128 Screen Displays Client Demographic Information

V. Selected For Matching

VI. OUTPUT TURNAROUND

VII. PF KEYS

VIII. ONLINE ERROR MESSAGES

IX. ERRORS AND UPDATES FROM 8128 UPDATE REPORT

EIS 4900 – DATA ENTRY APPENDIX I – CITIZENSHIP EXCEPTION SCREEN

I. GENERAL INFORMATION

II. ACCESS

III. RESOLVING THE EXCEPTIONS