NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3101

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CHANGES TO MEDICAID CASES

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EIS 3101 – CHANGES TO MEDICAID CASES

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)

DEDUCTIBLE TO AUTHORIZED

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

I. COMPLETING THE DSS-8125

A. Use the following instructions to change Medicaid status from deductible to authorized for any Medicaid case. If a numeric field requires less digits than spaces available, precede with zeroes.

1. Enter the CASEHEAD/PAYEE NAME at the top of the form for filing purposes.

2. Enter the COUNTY NAME.

3. Enter the CASE ID from the current Case Profile.

4. Enter your assigned WORKER NUMBER.

5. Enter the COUNTY NUMBER from the Case Profile.

6. Ensure the DISTRICT NUMBER on the Case Profile is correct. If incorrect, enter the appropriate DISTRICT NUMBER.

7. Enter the appropriate AID PROGRAM/CATEGORY.

8. Enter the appropriate CHANGE CODE if you are changing the MEDICAID STATUS. See the Codes Appendix to determine the appropriate code.

NOTE: FOR CAP CASES, DO NOT ENTER A CHANGE CODE. SEND A MANUAL NOTICE.

It is very important to enter the correct code. Unless overridden, an automated notice is produced based on the change code entered on the DSS-8125. The change code not only determines the text of the notice but also whether the notice is adequate or timely. See AUTOMATED NOTICES at the end of this section for more information regarding the automated notice.

9. Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice. Always override the automated notice when:

a. The change code used from the Codes Appendix is “other”.

b. The change code listed in the Codes Appendix is marked with an asterisk (*).

c. You use the DB/PML screen to issue benefits.

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

I. A. 9. (CONT'D) (DEDUCTIBLE TO AUTHORIZED)

NOTE: FOR CAP CASES, DO NOT ENTER NOTICE OVERRIDE OF “Y”. COMPLETE A MANUAL NOTICE.

10. Enter MEDICAID STATUS “A”. (Not allowed for I-AS, or M-QB cases.)

11. Enter the MEDICAID EFFECTIVE DATE.

12. Do not enter CERT FROM and CERT THRU unless you are changing the certification period.

13. Enter the DB/PML CODE. (Required for H-SF, M-AA, M-AB, M-AD, and M-AF cases. Not allowed for MAF-D cases.)

14. Enter the DB/PML AMOUNT. (Required for H-SF, M-AA, M-AB, M-AD, and M-AF cases. Not allowed for MAF-D cases.)

15. SUPPLEMENTAL NOTICE INFORMATION

The following three data elements have been added to the DSS-8125 Data Entry screen. A recommended form in which to enter the information can be found at the end of this section. This form should be attached to the DSS-8125 when submitting to Data Entry for keying.

a. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS

If an applicant had an authorized representative acting in his behalf, the authorized representative's name and address may be entered for the purpose of mailing an automated notice to the authorized representative in addition to the applicant.

b. SECONDARY NOTICE CODE

Do not enter for changes.

c. NOTICE TEXT

This section may be used if no code exists for your situation and/or to provide additional information to the recipient. If this text is used, you must enter change code “02” or “50”. If you enter Notice Text, you must enter a manual citation.



16. For a recipient who is incarcerated or in an Instituation for Mental Disease (IMD), enter the appropriate suspended living arrangement code. EIS automatically enters the appropriate Carolina Access exempt number for suspension based on the living arrangement entered.

B. DO NOT ENTER the following fields on the DSS-8125:

1. Verification Indicator

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

I. B. (CONT'D) (DEDUCTIBLE TO AUTHORIZED)

2. Application Data

3. Case Termination Data

4. Payment Data

5. Retro MA Data

6. Work Experience

7. Educational Level

8. Issue CRD

NOTE: ALL OTHER FIELDS ARE OPTIONAL. A DETAILED EXPLANATION OF EACH FIELD IS INCLUDED IN ”OTHER CHANGED DATA”.

II. SIGNATURES AND DATE

A. Enter the DATE COMPLETED.

B. Sign the DSS-8125 in the WORKER'S SIGNATURE field.

C. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

III. KEY THE DSS-8125.

IV. OUTPUTS

When the DSS-8125 processes successfully, the following are received:

A. Case Profile

An updated Case Profile is produced the night the change processes and is mailed to the county the following workday.

B. Benefit Issuance

If the recipient had not already been issued an annual Medicaid card that year, a card will be generated on the 4^th worknight from the end of the month and mailed the following workday.

C. Caseworker Supervisor Report

All changes completed by an IMC are reported on the Caseworker Supervisor Report. The number of actions completed is determined from the WORKER NUMBER.

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

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

VI. AUTOMATED NOTICES (DEDUCTIBLE TO AUTHORIZED)

A. General Information

1. An automated notice (DSS-8110A) is produced for all changes the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE”. A sample of the DSS-8110A is located at the end of this section.

2. The CHANGE CODE entered on the DSS-8125 determines the text of the notice and whether the notice is adequate or timely.

3. The system calculates the 60th calendar day for the notice.

4. The date of the automated notice is the next county workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient. A copy of the notice is not mailed to the county.

5. A Notice Register Report is produced each night and is mailed to the county the following workday. This report lists vital information related to all automated notices produced for that day. See EIS 3556 for more information regarding the Notice Register Report.

B. Adequate Notice

1. “Adequate” is indicated at the top of the notice.

2. The system calculates the 60th calendar day for the notice.

3. The action indicated on the DSS-8125 takes place in EIS the same night the adequate notice is produced.

C. Timely Notice

1. “Timely” is indicated at the top of the notice.

2. To produce an automated timely notice, you must complete the DSS-8125 and have it keyed into EIS at the same time you would have completed the manual DSS-8110.

3. The system calculates the tenth county workday and the 60th calendar day for the notice.

4. The action takes place in EIS eleven county workdays from the date of the notice. If the eleventh county workday falls after the 4th workday from the end of the month, EIS adjusts the month of change to the next benefit month.

REVISED 10/01/09 - CHANGE NO. 01-10

VI. C. 4. (CONT'D) (DEDUCTIBLE TO AUTHORIZED)

This action is reported on the Notice Register for that day. The information related to the automated notice is displayed with an asterisk (*) entered in the “CHANGE/TERMINATION DATE” column of the report.

5. No further action is required by you for the action to occur.

6. An updated Case Profile is produced the night the action takes place in EIS.

7. Deleting the Action

Because the action does not actually process in EIS until the eleventh county workday, it is possible to stop the action. To do so, you must delete the action that is on hold in EIS. The deletion must occur no later than the eleventh county workday from the date of the notice.

Delete the pending action using one of the following methods.

a. Submit a copy of the DSS-8125 you sent originally to request the change. Write “DELETE” in red across the top of the form; or

b. Submit a county form developed for this purpose. This form must contain the form ID number of the original DSS-8125 and a message to Data Entry to delete the form.

c. See EIS 4900, DATA ENTRY APPENDIX E.

NOTE: FORM ID NUMBERS ARE LISTED ON THE NOTICE REGISTERS AND ARE AVAILABLE THROUGH INQUIRY IN XPTR FOR THREE DAYS AFTER THE DSS-8125 IS KEYED.

This action is reported on the Notice Register for that day. The information related to the automated notice is displayed with “DELETED” noted in the “COMMENTS” column of the register.

REISSUED 10/01/09 - CHANGE NO. 01-10

VI. C. (CONT'D) (DEDUCTIBLE TO AUTHORIZED)

8. Rescinding the Action

There is another situation where an action pending in EIS is stopped.

If a subsequent DSS-8125 is keyed by the eleventh county workday from the date of the notice and the subsequent DSS-8125 causes a new notice to be produced, the pending action is stopped. In this situation, EIS “rescinds” the pending action and produces an automated notice for the new action.

Both actions are reported on the Notice Register for that day. The information related to the first automated notice is displayed with “RESCINDED” noted in the “COMMENTS” column of the register. The information related to the subsequent automated notice is also displayed with no entry in the “COMMENTS” column.

9. DSS-8125 and Timely Pending Action

a. A DSS-8125 may not be placed on hold when there is a timely action pending.

b. A DSS-8125 may be keyed, but if a change code or termination code is present, it will rescind the pending action.

c. Demographic data may be keyed up until the day before a timely action is to process without rescinding the pending action. Following are examples of demographic data:

(1) County Number

(2) County Case Number

(3) District Number

(4) Address

(5) RSDI Claim Number