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NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL
ELIGIBILITY INFORMATION SYSTEM EIS 2400
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DSS-8124 APPLICATION SCREEN AND DSS-8124I
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I. DSS-8124 APPLICATION SCREEN AND DSS-8124I
REVISED 03/01/10 - CHANGE NO. 03-10
Information entered on the DSS-8124 is used to gather EIS statistical information. Some of the information entered on the DSS-8124 can affect the calculation of the compliance threshold on the county report card.
Refer to EIS 4900 APPENDIX B for information on how to access and key the DSS-8124 Application Screen.
The DSS-8124 Application Screen is displayed below along with an explanation of some of the key data elements.
Applications that are indicated as “ADMINISTRATIVE” are excluded from compliance threshold reporting. Work First and Medicaid policy give information for determining which applications should be coded as Administrative Actions.
To indicate an ADMINISTRATIVE action, key “Y” in the “ADMIN” field at the top of the DSS-8124.
REVISED 03/01/10 - CHANGE NO. 03-10
I.A. (CONT'D)
Applications that are indicated as “TRANSITIONAL” are excluded from the compliance thresholds.
To indicate a TRANSITIONAL application, key “Y” in the “TRANS” field at the top of the DSS-8124.
3. “HOW APP RECEIVED?”
For MAF, MPW, MIC, MAABD, MQB and NC Health Choice applications, this field is used to report the source from which the application is received. Enter “M” if the application is received by mail, “H” if the application is received from the Health Department, “A” if the application is received from an Aging Center, or “D” if the application is taken at the county dss.
The application is coded “D” regardless of the source of the application form when a face to face interview is conducted by a dss employee. For example, the dss caseworker assigned to the county Health Department conducts an application interview in the Health Department with a form from the Health Department. This application is coded “D”.
“L” Indicates a Low Income Subsidy/Medicaid Application.
If the application is for MQB and it is for a Qualifying Individual (MQB-E), enter “Y” for “QI1”. Otherwise, enter “N”.
Enter “Y” if the application is for NC Health Choice or “N” if the application is for MIC (Medicaid). Leave blank for all other aid program/categories.
Enter “Y” if the application is for MAF-D, Family Planning. Otherwise, enter “N”.
REISSUED 03/01/10 - CHANGE NO. 03-10
I.A. (CONT'D)
All MAD applications require an entry in these fields. The Date Screen is built from the indicator entered on the DSS-8124.
To indicate an MAD application does not need a disability determination, key “N” on the DSS-8124. To indicate an MAD application needs disability determination, key “Y” on the DSS-8124.
On the Date Screen by “DDS Required:”, change the “N” to “Y” or “Y” to “N” as needed. If the application is a two-part MAD, the ongoing and retro Date Screens would both need to be changed if a change is needed for both parts.
MAD Denial/Withdrawal at application registration must be entered using a two-step process.
REISSUED 03/01/10 - CHANGE NO. 03-10
An indicator is displayed on the DSS-8124I turnaround form to identify an application as an ADMINISTRATIVE action or a TRANSITIONAL application in the “APPLICATION TYPE” box. This box is located in the upper right hand corner of the form. The indicators are displayed as “ADMIN-Y” or “TRANS-Y”, depending on which action you key.
When an MAF application is keyed, an indicator is displayed on the DSS-8124I form as FAM PLAN “Y” or “N”, depending on which action is keyed.
When an MAD application is registed as either, “N”, a disability determination is NOT needed, or “Y”, a disability determination IS needed, the “N” and/or “Y” display on the DSS-8124I turnaround form in the DIS/DET “ONGOING” and/or “RETRO” indicator fields. These fields are located in the upper left hand corner of the 8124I form. The fields are populated with “N” or “Y” based on the information entered on the DSS-8124.
One-part MAD applications (types 1 or 2) cannot be changed to two-part (types 4 or 5).
Either make the one part MAD application Administrative (Refer to EIS 2400, II., for instructions to ensure the application is changed to administrative.) and deny. Then, complete a two-part DSS-8124; or
Key another NEW one-part DSS-8124 with the same date of application for the other part needed.
NOTE: IF YOU KEY THE “Y” FOR ADMINISTRATIVE AT THE SAME TIME YOU KEY THE DENIAL/WITHDRAWAL INFORMATION AND PRESS ENTER, THE SYSTEM WILL NOT PROCESS THE APPLICATION AS ADMINISTRATIVE. THE APPLICATION WILL BE CALCULATED IN THE COMPLIANCE THRESHOLD OF THE REPORT CARD.
Refer to EIS 2400, II., for instructions on what to do when an application is taken in error or is keyed with the wrong date of application.
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