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NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3100

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MAKING CHANGES TO CASES

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EIS 3100 - MAKING CHANGES TO CASES

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 3100 - MAKING CHANGES TO CASES

REVISED 01/01/06 - CHANGE NO. 03-06

TABLE OF CONTENTS

GENERAL INFORMATION	EIS 3100

	PAGE
General Instructions	1
Updating Medicaid Effective Date	1
Updating Payment Effective Date	2
Removal Of Information	2
Updating Information For A Timely Notice	3

CHANGES TO MEDICAID CASES	EIS 3101

Change of Address	1
Change in Living Arrangement	4
Change in Medicaid Classification	11
Payee Name Change and Changes of Payee	17
Deductible to Authorized	25
Deletion of an Individual	31
Authorized to Deductible (Including Income Change)	37
Special Coverage
Community Alternative Program (CAP)	44
	Change to a Terminated Case	55
Change in Medicare Status	57
Other Changed Data	60

CHANGES TO REFUGEE AND SPECIAL ASSISTANCE CASES	EIS 3102

Change of Address	1
Payee Name Changes and Changes of Payee	4
Deletion of an Individual	10
Grant Recoupment	17
Payment Revision	23
Special Coverage
Community Alternative Program (CAP)	30
	Special Assistance Higher Level of Care	34
	Substitute Payee	37
Continuation Cases	39
Change to a Terminated Case	41
Change in Stepparent Indicator	42
Other Changed Data	44

REISSUED 10/01/07 - CHANGE NO. 02-08

GENERAL INFORMATION

I. GENERAL INSTRUCTIONS

A. Use the DSS-8125, Eligibility Information System Data Sheet and/or the NAME CHANGE screen to make changes to case and/or individual information. Review the current Case Profile to determine what information is currently in EIS for the case/individual.

Find the specific change you wish to perform in the Table of Contents. Then turn to the referenced page number for instructions.

B. If a case requires more than one change, refer to the appropriate sections for instructions on each type of change.

C. Complete a DSS-8126, Continuation Sheet, as a continuation of the DSS-8125 to enter individual data when there is more than one person. If there are five or more individuals complete a second DSS-8126(s). A sample of the DSS-8126 is located at the end of this volume.

II. UPDATING MEDICAID EFFECTIVE DATE

Certain changes to a case require the Medicaid effective date to be updated. When the following information changes, update the Medicaid effective date.

A. Add-An-Individual

B. Aid Program/Category Transfers

C. Approvals for the Ongoing Period

D. Deductible Balance (DB)

E. Patient Monthly Liability (PML)

F. Medicaid Classification

G. Medicaid Status

H. Medicaid Redeterminations

I. Payment Type (When changing from “1” or “2” to “4”, “5”, or “9”.)

REISSUED 10/01/07 - CHANGE NO. 02-08

III. UPDATING PAYMENT EFFECTIVE DATE

(A-AF, R-RF, and SA only)

Certain changes to a case require the payment effective date to be updated. When the following information changes, update the payment effective date.

A. Add-An-Individual

B. Delete An Individual

C. Grant Recoupment Data

D. Maintenance Amount

E. Monthly Payment Amount

F. Total Countable Monthly Income

IV. REMOVAL OF INFORMATION

A. Information may be removed from money amount fields by entering zeroes.

B. The following information may be removed by entering an asterisk (*) in the first position of the field on the DSS-8125.

1. Case Level

a. Subpayee Code

b. Subpayee Middle Initial (Initial only removed)

c. Subpayee Suffix (Suffix only removed)

d. Address Line 2

e. Phone Number

f. New County Number

g. Deductible Balance/Patient Monthly Liability (This will also delete the DB/PML Amount.)

h. Special Review Code and Date (Enter the Code you want deleted in the Special Review Code field, then enter an asterisk in the first position of the date field).

For example, Citizenship may require an 8125 to be keyed with the Special Review Code (Z) and date. If the citizenship/identity documentation is received prior to the Special Review Date, the Special Review Code and Date can be deleted.

REVISED 02/01/11 - CHANGE NO. 03-11

IV. B. 1. (CONT'D)

i. Food Stamp Number

j. Ambulation Capacity

k. Grant Recoupment Code (Enter zeroes in the Amount and Date fields.)

l. Stepparent Indicator (MAF, MIC, or MRF only)

m. Special Use Data (Enter the Code you want deleted in the Special Use Code field.)

n. Authorized Representative/CAP Manager/PACE Agency (Entering an asterisk (*) in the first space of the name field removes all data.)

2. Individual Level

a. Special Report Code

b. RSDI Claim Number

c. Special Use Data (Enter the Code you want deleted in the Special Use Code Field)

d. Refugee Status Code (To remove a Refugee Status Code, when the Citizen/ID code is 60-66, both the Refugee Status Code and the Citizen/ID must be deleted on the same DSS-8125. Both codes and the dates are deleted. The Alien ID will be automatically deleted).

e. Jobs/Work Registration/Exemption Code

f. Work Experience Code

g. Educational Level Code

h. Citizen/ID Code (Key ** in the code field. Both the code and date are deleted. If the Citizen/ID of 60-66 needs to be deleted, the Refugee Status Code must be removed on the same DSS-8125. The Alien ID will be automatically removed).

C. Relationship To Payee indicator can be changed to any valid code but cannot be removed to become a blank value.

V. UPDATING INFORMATION FOR A TIMELY NOTICE

Certain changes to a case or individual require a timely (10 workday) notice. When information is keyed on a DSS-8125 using a timely notice code, some information processes the same night the DSS-8125 is keyed. Other information is held by EIS and will not process until the 10 workday period has elapsed.

REISSUED 02/01/11 – CHANGE NO. 03-11

V. (CONT’D)

The following information is held by EIS until the 10 workday period has elapsed. All other information not listed below processes on the night the DSS-8125 is keyed.

EIS 3100 - MAKING CHANGES TO CASES

EIS 3100 - MAKING CHANGES TO CASES

I. GENERAL INSTRUCTIONS

A. Use the DSS-8125, Eligibility Information System Data Sheet and/or the NAME CHANGE screen to make changes to case and/or individual information. Review the current Case Profile to determine what information is currently in EIS for the case/individual.

B. If a case requires more than one change, refer to the appropriate sections for instructions on each type of change.

C. Complete a DSS-8126, Continuation Sheet, as a continuation of the DSS-8125 to enter individual data when there is more than one person. If there are five or more individuals complete a second DSS-8126(s). A sample of the DSS-8126 is located at the end of this volume.

II. UPDATING MEDICAID EFFECTIVE DATE

A. Add-An-Individual

B. Aid Program/Category Transfers

C. Approvals for the Ongoing Period

D. Deductible Balance (DB)

E. Patient Monthly Liability (PML)

F. Medicaid Classification

G. Medicaid Status

H. Medicaid Redeterminations

I. Payment Type (When changing from “1” or “2” to “4”, “5”, or “9”.)

III. UPDATING PAYMENT EFFECTIVE DATE

A. Add-An-Individual

B. Delete An Individual

C. Grant Recoupment Data

D. Maintenance Amount

E. Monthly Payment Amount

F. Total Countable Monthly Income

IV. REMOVAL OF INFORMATION

A. Information may be removed from money amount fields by entering zeroes.

B. The following information may be removed by entering an asterisk (*) in the first position of the field on the DSS-8125.

1. Case Level

a. Subpayee Code

b. Subpayee Middle Initial (Initial only removed)

c. Subpayee Suffix (Suffix only removed)

d. Address Line 2

e. Phone Number

f. New County Number

g. Deductible Balance/Patient Monthly Liability (This will also delete the DB/PML Amount.)

h. Special Review Code and Date (Enter the Code you want deleted in the Special Review Code field, then enter an asterisk in the first position of the date field).

i. Food Stamp Number

j. Ambulation Capacity

k. Grant Recoupment Code (Enter zeroes in the Amount and Date fields.)

l. Stepparent Indicator (MAF, MIC, or MRF only)

m. Special Use Data (Enter the Code you want deleted in the Special Use Code field.)

2. Individual Level

a. Special Report Code

b. RSDI Claim Number

c. Special Use Data (Enter the Code you want deleted in the Special Use Code Field)

d. Refugee Status Code (To remove a Refugee Status Code, when the Citizen/ID code is 60-66, both the Refugee Status Code and the Citizen/ID must be deleted on the same DSS-8125. Both codes and the dates are deleted. The Alien ID will be automatically deleted).

e. Jobs/Work Registration/Exemption Code

f. Work Experience Code

g. Educational Level Code

h. Citizen/ID Code (Key ** in the code field. Both the code and date are deleted. If the Citizen/ID of 60-66 needs to be deleted, the Refugee Status Code must be removed on the same DSS-8125. The Alien ID will be automatically removed).

C. Relationship To Payee indicator can be changed to any valid code but cannot be removed to become a blank value.

V. UPDATING INFORMATION FOR A TIMELY NOTICE

A. Case Information

1. District Number

2. Termination Date

3. Termination Reason

4. Aid Program/Category

5. Payment Review Period

6. Medicaid Status

7. Medicaid Effective Date

8. Medicaid Certification Period

9. Monthly Payment Amount

10. Payment Effective Date

11. Medicaid Class

12. DB/PML

13. DB/PML Amount

14. Deductible Amount

15. Gross Earned Income

16. Disregard

17. Net Earned Income

18. SSI Amount

19. Maintenance Amount

20. Work Expenses

21. RSDI Amount

22. Child Adult Care

23. Total Unearned Income

24. Job Work Savings

25. Grant Recoupment

26. Total Monthly Income

27. Sanction MRA

28. Sanction IV-D