NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2500

-----------------------------------------------------------------------

PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE)

-----------------------------------------------------------------------

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) Table of Contents



REVISED 03/01/10 - CHANGE NO. 03-10

TABLE OF CONTENTS

PAGE

I. INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . 1

II. PACE POLICY . . . . . . . . . . . . . . . . . . . . . . . . 1-2

III. PACE AUTHORIZATION . . . . . . . . . . . . . . . . . . . . 2-4

A. DSS-8125 Mandatory Fields . . . . . . . . . . . . . . 2

B. Approvals . . . . . . . . . . . . . . . . . . . . . . 2-3

C. Late Redeterminations . . . . . . . . . . . . . . . . 3-4

IV. PACE AUTHORIZATION SCREEN INSTRUCTIONS
ENTRY VIA THE DSS-8125 . . . . . . . . . . . . . . . . . . 4-10

A. General Information . . . . . . . . . . . . . . . . . 4-5

B. Screen Instructions – Initial PACE Authorization . . . 5-7

C. PACE Authorization Errors . . . . . . . . . . . . . . 7

D. Screen Instructions - Redeterminations . . . . . . . . 7-10

V. PACE END DATE SCREEN INSTRUCTIONS . . . . . . . . . . . . . 10-11

VI. PACE/MANAGED CARE HISTORY INQUIRY . . . . . . . . . . . . . 11

VII. PACE PROVIDER DATA INQUIRY . . . . . . . . . . . . . . . . 11-12

VIII. CASE DATA INQUIRY . . . . . . . . . . . . . . . . . . . . . 12

IX. INDIVIDUAL AND MEDICAID ELIGIBILITY HISTORY INQUIRY . . . . 12

A. ID Inquiry . . . . . . . . . . . . . . . . . . . . . . 12-13

B. IE Inquiry . . . . . . . . . . . . . . . . . . . . . . 13

X. COUNTY TRANSFERS . . . . . . . . . . . . . . . . . . . . . . 13-14

A. Move to another PACE County with Same Provider . . . . 13-14

B. Move to Non-PACE County . . . . . . . . . . . . . . . 14

C. Move from PACE County to PACE County with Different
Providers. . . . . . . . . . . . . . . . . . . . . . . 14

XI. ID CARDS FOR PACE RECIPIENTS . . . . . . . . . . . . . . . 15

REVISED 03/01/10 – CHANGE NO. 03-10

XII. PACE NOTICES/CODES . . . . . . . . . . . . . . . . . . . . . 15-17

XIII. PACE COUNTIES AND PROVIDERS . . . . . . . . . . . . . . . . 17-18

XIV. PACE PATIENT MONTHLY LIABILITY. . . . . . . . . . . . . . . 18

XV. PACE CORRECTIONS. . . . . . . . . . . . . . . . . . . . . . 18

XVI. PACE REPORTS . . . . . . . . . . . . . . . . . . . . . . . . 18-19