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. 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
OTHER CHANGED DATA
REISSUED 01/01/06 - CHANGE NO. 03-06
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.
A. Case ID.
B. County Number.
C. Aid Program/Category.
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.
A. CASE LEVEL DATA
1. CASE ID: Enter the eight digit Case ID from the Current Case Profile. This number does not change.
2. WORKER NUMBER: This is a three digit alpha/numeric field. Enter or correct your worker number.
3. COUNTY NUMBER: Enter your two digit county number from the Current Case Profile.
4. COUNTY CASE NUMBER: This is a six digit alpha/numeric field. Enter or correct the case number from the Case Profile.
5. DISTRICT NUMBER: This is a three digit alpha/numeric field. Enter or correct the district number from the Case Profile.
6. COUNTY REASSIGNMENT NEW COUNTY NUMBER AND DATE: Do not enter. See “County Transfers for Active Cases”, EIS 3500.
7. AID PROGRAM/CATEGORY: The aid program/category must be the same as the current aid program/category. If you are changing the aid program/category, see “Aid Program/Category Transfer”, EIS 3451.
11. PHONE NUMBER: This is a numeric field. Enter the
three-digit area code and seven-digit phone number of the casehead/payee initially or to correct the phone number on the Case Profile.
REISSUED 07/01/10 - CHANGE NO. 01-11
II. A. (CONT'D) (OTHER CHANGED DATA)
12. VERIFICATION INDICATOR: Do not enter for changes.
13. SUBSTITUTE PAYEE: Enter the substitute payee code, first name, middle initial, last name, and suffix as appropriate. See the Codes Appendix to determine the appropriate substitute payee code.
14. CHANGE CODE: Enter the change reason code if any of the following fields were entered:
a. Deductible Amount
b. Medicaid Classification
c. DB/PML Type
d. DB/PML Amount
e. Medicaid Status
f. Individual Termination Date
g. Medicare B. You must enter Notice Override of “Y”.
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.
NOTE: EXCEPTION: YOU MAY UTILIZE CHANGE NOTICE CODES 02 AND 50 WHICH DO NOT REQUIRE NOTICE OVERRIDE
15. NOTICE OVERRIDE: Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice. Always override the automated notice when:
REISSUED 07/01/10 CHANGE NO. 01-11
II. A. (CONT'D) (OTHER CHANGED DATA)
16. APPLICATION DATA fields: Do not enter. See the appropriate Approving An Application, Reapplication, and
Add-An-Individual Section.
17. CASE TERMINATION DATA fields: Do not enter. See “Terminating a Case”, EIS 3200.
B. PAYMENT DATA: Do not enter.
C. MEDICAID DATA
1. MEDICAID STATUS: If a change in Medicaid status is made, you must update the MEDICAID EFFECTIVE DATE.
2. MEDICAID EFFECTIVE DATE: This is a six digit field. Update Medicaid effective date when:
a. Adding an Individual
b. Aid Program/Category Transfers
c. Deductible Balance (DB) Changes
d. Patient Monthly Liability (PML) Changes
e. Medicaid Classification Changes
f. Medicaid Status Changes
g. Redeterminations
3. MEDICAID CERTIFICATION FROM AND THRU DATES. Do not change the FROM DATE. You may change the THRU DATE to align the certification period with that of another case. For Redeterminations, see EIS 3051.
You may shorten the certification period for any Medicaid program. Do not reenter the FROM DATE. ENTER the revised THRU DATE.
MPW is the only aid program/category for which the certification period can be extended. Do not reenter the FROM DATE. Enter the revised THRU DATE.
REVISED 07/01/10 - CHANGE NO. 01-11
II. C. 3. (CONT'D) (OTHER CHANGED DATA)
REVISED 07/01/10 - CHANGE NO. 01-11
II. (CONT'D) (OTHER CHANGED DATA)
G. NEEDS DATA
1. MAINTENANCE AMOUNT: This is a six digit, numeric, dollars and cents field.
2. AMBULATION CAPACITY: Do not enter.
3. DOMICILIARY RATE: Do not enter.
4. TOTAL COUNTABLE MONTHLY INCOME: This is a six digit, numeric, dollars and cents field. This field is required if TOTAL NET UNEARNED INCOME or NET EARNED INCOME are present.
G. SPECIAL DATA
1. FOOD STAMP NUMBER: This is a seven digit alpha/numeric field.
2. STEPPARENT INDICATOR: A one-digit numeric field. Optional for MAF, MIC, and MRF. Not allowed for any other Medicaid Program.
3. GRANDFATHER STATUS: This field may not be changed.
4. SSI STATUS: System-controlled field-May not be changed.
5. VA PAYMENT: Mark “Yes” or “No”. If yes, include payment in OTHER UNEARNED INCOME.
6. SPECIAL REVIEW TYPE: This is an alpha/numeric code. See the Codes Appendix to determine the appropriate special review code. If entered, SPECIAL REVIEW DATE is required.
7. SPECIAL REVIEW DATE: This is a four digit numeric field and must be MMYY. The date must not be before the current processing month.
8. JOBS/WORK REQUIREMENT SAVINGS REASON: Do not enter.
9. JOBS/WORK REQUIREMENT SAVINGS AMOUNT: Do not enter.
REISSUED 02/01/11 - CHANGE NO. 03-11
II. G. (CONT'D) (OTHER CHANGED DATA)
10. SPECIAL USE CODE: This is a two digit alpha code. See the Codes Appendix to determine the appropriate special use code. If entered, SPECIAL USE DATA is required.
11. SPECIAL USE DATA: This is a twelve digit numeric field. If entered, SPECIAL USE CODE is required.
H. SPECIAL COVERAGE GROUP DATA (1, 2, and 3)
1. CODE: This is a two digit alpha field. See the Codes Appendix to determine the appropriate special coverage group code. If entered, BEGIN DATE is required.
2. BEGIN DATE: This is a six digit numeric field. The data must contain MMDDYY and must be the first day of the month. This field is required if SPECIAL COVERAGE CODE is entered.
3. END DATE: This is a six digit numeric field. The data must contain MMDDYY and must be after the Begin Date. It must be the last day of the month. If entered, SPECIAL COVERAGE CODE and BEGIN DATE are required.
I. SUB PROGRAM GROUP DATA (1, 2, AND 3)
1. CODE: This is a two digit field alpha/numeric. See the Codes Appendix to determine the appropriate sub program group code. If entered, BEGIN DATE is required.
2. BEGIN DATE: This is a six digit numeric field. The data must contain MMDDYY and must be the first day of the month. This field is required if SUB PROGRAM CODE is entered.
3. END DATE: This is a six digit numeric field. The data must contain MMDDYY and must be after the Begin Date. It must be the last day of the month. If entered, SUB PROGRAM CODE and BEGIN DATE are required.
J. FEDERAL POVERTY LEVEL
1. CODE: This is a two digit field alpha/numeric that is entered right after you enter your sub program codes. See the Codes Appendix to determine the appropriate federal poverty level codes. A code is required for Health Coverage for Working Disabled (HCWD)sub programs.
2. BEGIN DATE: This is a six digit numeric field. The data must contain MMDDYY and must be the first day of the month. This field is required if SUB PROGRAM CODE and FEDERAL POVERTY LEVEL is entered.
3. END DATE: This is a six digit numeric field. The data must contain MMDDYY and must be after the Begin Date. It must be the last day of the month. If entered, SUB PROGRAM CODE, FEDERAL POVERTY LEVEL and BEGIN DATE are required.
REVISED 02/01/11 - CHANGE NO. 03-11
II. (CONT'D) (OTHER CHANGED DATA)
1. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS
If an applicant had an authorized representative/CAP Manager or PACE Agency 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. See EIS-2250.
NOTE: Entry of this field only does not generate an automated notice.
2. SECONDARY NOTICE CODE
3. NOTICE TEXT
This section may be used if there is no code for your situation and/or to provide additional information to the recipient. If this text is used, enter change code “02” or “50”. If you enter Notice Text, enter a manual citation.
M. SPOUSE INDICATOR
This is a one digit alpha field, “Y” (YES) or “N” (NO). For appropriate code see the Codes Appendix. For MAABD and MQB aid program/categories ONLY.
N. INDIVIDUAL DATA
1. INDIVIDUAL ID: The individual ID number for each individual included in the case is brought forward. You may not key in this field.
2. INDIVIDUAL NAME: The names of all the individuals included on the case. You may not key in this field. Correct the name on the NAME CHANGE screen.
3. SOCIAL SECURITY NUMBER: This is a nine digit numeric field. You may not key in this field. Correct the social security number on the NAME CHANGE screen.
5. CASE STATUS: Do not enter.
REISSUED 05/01/09 - CHANGE NO. 03-09
II.N. (CONT'D) (OTHER CHANGED DATA)
6. DATE OF BIRTH: This is an eight digit numeric field (MMDDYYYY). You may not key in this field. Correct the date of birth on the NAME CHANGE screen.
7. RACE: This is a one digit alpha field. You may not key in this field. Correct the race on the NAME CHANGE screen.
8. SEX: This is a one digit alpha field, “M” (MALE) or “F” (FEMALE). You may not key in this field. Correct the sex on the NAME CHANGE screen.
9. RSDI CLAIM NUMBER: This is a twelve digit alpha/numeric field. This field is required if RSDI AMOUNT is entered and/or if either Medicare field is marked “Y”.
10. MEDICARE A: Mark “Y” or “N”. If “Y” is entered, the RSDI CLAIM NUMBER is required.
Note: If Medicare A is “Y” or “Z”, Medicaid Class “D”, Family Planning, is not allowed.
11. MEDICARE B: Mark “Y” or “N”. If “Y” is entered, the RSDI CLAIM NUMBER is required.
Note: If Medicare B is “Y” or “Z”, Medicaid Class “D”, Family Planning is not allowed.
12. FAMILY STATUS: Do not enter.
13. LIVING ARRANGEMENT: See “Change in Living Arrangement”.
14. SPECIAL REPORT: This is a one digit alpha field. See the Codes Appendix to determine the appropriate special report code.
15. JOBS/WORK REGISTRATION/EXEMPTION: Do not enter.
16. SPECIAL USE CODE: This is a two digit alpha field. See the Codes Appendix to determine the appropriate special use code. If entered, SPECIAL USE DATA is required.
17. SPECIAL USE DATA: This is a twelve digit numeric field. If entered, SPECIAL USE CODE is required. The data must contain MMDDYY. See the Codes Appendix to determine the appropriate special use data.
18. REFUGEE STATUS CODE: This is a two digit alpha field. See the Codes Appendix to determine the appropriate refugee status code. The U.S. ENTRY DATE is required. If a Refugee Status Code is entered, an Alien ID and a Citizenship/ID code is required.
REISSUED 05/01/09 - CHANGE NO. 03-09
II.N. (CONT'D) (OTHER CHANGED DATA)
19. U.S. ENTRY DATE: This is a six digit numeric field. The data must contain MMCCYY. A REFUGEE STATUS CODE is required. The date must be the same for each individual with a refugee status code. The date must not be greater than 12
months prior to the month of application for the case (MRF only).
20. DATE OF DEATH: This is a six digit numeric field. The format is MMDDYY. The date must be before or the same as the current date. If entered, the change code must be “52”. If this is the only individual on the case, see “Terminating a Case”, EIS 3200.
21. CITIZEN/ID: This is a two digit numeric field followed by an eight digit date field. The format for the date is MMDDCCYY. If a Citizenship/ID code of 60, 61, 62, 63, 64 65, or 66 is entered, a Refugee Status Code/Date, and an Alien ID code is required. See EIS 4000 for codes and date criteria.
22. Alien ID: This is a numeric field that has the capacity to enter up to 9 digits. The alpha “A” is not entered. In the future, to allow for expansion, this field will allow up to 13 numeric digits. If an Alien ID is entered, a Refugee Status Code/Date and a Citizenship/ID code of 60, 61, 62 63,64, 65, or 66 is required. If a Citizensip/ID code of 51 is entered for a Lawful Permanent Resident (LPR), a Refugee Status Code/Date and Alien ID are not required.
23. REL TO PAYEE: This is a one digit alpha code. (The field space is two digits to allow for future codes.) See EIS 4000 for codes.
24. SPECIAL NEEDS: This is a one digit numeric field. See EIS 4000 for codes.
25. E&T: Do not enter.
26. JOBS/WORK REQUIREMENT SAVINGS REASON: Do not enter.
27. JOBS/WORK REQUIREMENT SAVINGS AMOUNT. Do not enter.
28. ED. EMPL: Do not enter.
29. WORK EXPERIENCE: Do not enter.
30. GROSS EARNED INCOME: Do not enter.
31. WORK EXPENSES: Do not enter.
REISSUED 05/01/09 - CHANGE NO. 03-09
II.N. (CONT'D) (OTHER CHANGED DATA)
32. CHILD/ADULT CARE: Do not enter.
33. NET EARNED INCOME: Do not enter.
34. EDUCATIONAL LEVEL: Do not enter.
35. EPICS CLAIM INDICATOR: Do not enter.
III. SIGNATURES AND DATE
1. Enter the DATE COMPLETED.
2. WORKER'S SIGNATURE: Write your name is this field.
3. DIRECTOR'S SIGNATURE: The county director or his designee must sign the form in this field.
IV. KEY THE DSS-8125.
V. OUTPUTS
A. Case Profile
An updated Case Profile is produced the night the change processes and is mailed to the county the following workday.
B. 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.
VI. AUTOMATED NOTICES
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.
REISSUED 05/01/09 - CHANGE NO. 03-09
VI.A (CONT'D) (OTHER CHANGED DATA)
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 pull, EIS adjusts the month of change to the next benefit month.
For example: A DSS-8125 indicating a change with an effective date of July 1, 1996, and a timely reason code for an automated notice is keyed June 12, 1996. The eleventh workday is June 28, 1996. The pull deadline is June 25, 1996.EIS changes the Medicaid Effective Date to August 1, 1996.
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.
ISSUED 05/01/09 - CHANGE NO. 03-09
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, 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.
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.
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 also is displayed with no entry in the “COMMENTS” column.
ISSUED 05/01/09 - CHANGE NO. 03-09
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
