NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 4000

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CODES APPENDIX B - MEDICAID CODES

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EIS 4000 – CODES APPENDIX B – MEDICAID CODES


CHANGE CODES - MEDICAID CHANGES

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS FOR NON-SSI CASES WITH A CERT. THROUGH DATE OF 12/31/9999.

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS FOR NON-SSI CASES WITH A CERT. THROUGH DATE OF 12/31/9999 (CONT’D)

DISPOSITION CODES - MEDICAL ASSISTANCE APPROVALS

DISPOSITION CODES - MEDICAL ASSISTANCE DENIALS(G8 IS THE ONLY DENIAL CODE FOR M-SB CASES.)

DISPOSITION CODES – MEDICAL ASSISTANCE WITHDRAWALS

MEDICAID TERMINATION CODES

TRANSFERS (AID PROGRAM/CATEGORY)


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**NOTE: NC HEALTH CHOICE CODES ARE LOCATED IN EIS-4300 PART SIX.**

NOTE: USE SPECIFIC BREAST AND CERVICAL CANCER MEDICAID (BCCM) CODES AS INDICATED. IF A SPECIFIC BCCM CODE IS NOT AVAILABLE, USE THE APPROPRIATE MAF CODE.

DISPOSITION CODES

TERMINATIONS

TRANSFERS (AID PROGRAM/CATEGORY)

EIS 4000 – CODES APPENDIX B – MEDICAID CODES

REISSUED 01/01/06 – CHANGE NO. 03-06

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CHANGE CODES - MEDICAID CHANGES

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

DSS-8110A

Based on the “ADEQUATE” or “TIMELY” change code entered on the
DSS-8125, EIS generates an automated notice for Medicaid benefit case actions. The notice contains the following information:

REVISED 01/01/06 – CHANGE NO. 03-06

MA CHANGE CODES (CONT'D)

REISSUED 01/01/06 – CHANGE NO. 03-06

MA CHANGE CODES (CONT’D)

REASON

TIMELY

ADEQUATE

     

Your countable income has decreased. (Section 2340 and 2250 of the Aged, Blind, Disabled Manual or Section 3300 of the Family and Children's Manual.)

N/A

51

     

Your income increased. (Sections 2340 and 2250 of the Aged, Blind, and Disabled Manual or Section 3300 of the Family and Children's Manual.)

03

53

     

The state income levels changed. (Section 2260 of the Aged, Blind, and Disabled Manual, or Sections 3305 and 3310 of the Family and Children's Manual.)

08

58

REASON

TIMELY

ADEQUATE

     

You met your Medicaid deductible. (Section 2340 and 2360 of the Aged, Blind, and Disabled Manual or Section 3315 of the Family and Children's Manual.)

N/A

55

     

An individual with countable income moved out of your household. (Section 2260 of the Aged, Blind, and Disabled Manual or Section 3305 of the Family and Children's Manual.)

1L

63

     

You had a change in who lives in your household. (Section 2260 of the Aged, Blind, and Disabled Manual or Section 3305 of the Family and Children's Manual.)

11

6M

REISSUED 01/01/06 – CHANGE NO. 03-06

MA CHANGE CODES (CONT’D)

REASON

TIMELY

ADEQUATE

     

Your medical costs not covered by Medicaid decreased. (Section 2270 of the Aged, Blind, and Disabled Manual or Section 3325 of the Family and Children's Manual.)

04

54

     

The needs of your spouse decreased. (Section 2270 of the Aged, Blind, and Disabled Manual or Section 3325 of the Family and Children's Manual.)

05

5J

     

Your medical costs not covered by Medicaid increased. (Section 2270 of the Aged, Blind, and Disabled Manual or Section 3325 of the Family and Children's Manual.)

N/A

56

     

The needs of your spouse increased. (Section 2270 of the Aged, Blind, and Disabled Manual or Section 3325 of the Family and Children's Manual.)

N/A

57

     

You entered a long term care facility. (Section 2270 of the Aged, Blind, and Disabled Manual or Section 3325 of the Family and Children’s Manual.)

N/A

68

REASON

TIMELY

ADEQUATE

     

Your income exceeds the income level, causing you to have a deductible. (Section 2360 of the Aged, Blind, and Disabled Manual or Section 3315 of the Family and Children's Manual.)

1J

60

REISSUED 3/01/10 – CHANGE NO. 03-10

MA CHANGE CODES (CONT’D)

REASON

TIMELY

ADEQUATE

     

A child in the case has reached age 19. (Section 3230 and 3235 of the Family and Children’s Manual.)

06

70

     

This individual has reached age 21. (Section 3230 of the Family and Children's Manual.)

07

5K

     

This child’s income is more than the income limit. (Section 3305 of the Family and Children’s Manual.)

09

6H

     

This person is no longer in the home. (Section 3235 of the Family and Children's Manual.)

10

6L

     

The individual is being terminated at your verbal request. (Section 3410 of the Family and Children's Manual.)

13

6N

     

The child no longer lives with you. (Section 3230 and 3235 of the Family and Children’s Manual.)

17

95

     

You have failed to provide a social security number. (Section 3355 of the Family and Children’s Manual.)

18

6G

     

The individual moved out of state. (Section 3335 of the Family and Children's Manual.)

1K

62

     

The child no longer lives with you because of placement in foster care or an adoptive home. (Section 3230 and 3235 of the Family and Children's Manual.)

1M

64

     

The parent returned home. (Section 3235 of the Family and Children's Manual.)

21

6P

     

The individual was found eligible for Medicaid in another category. (Section 3410 of the Family and Children's Manual.)

2B

71

REVISED 3/01/10 – CHANGE NO. 03-10

REASON

TIMELY

ADEQUATE

     

Your income is over the income limit for full Medicaid coverage causing you to have a deductible. (Section 3305 of the Family and Children’s Manual.)

37

97

     

You have not provided necessary information to document citizenship and/or identity. (Section 3215 of the Family and Children’s Manual.)

3Z

6Z

     

You did not provide documentation of citizenship and/or identity (Individual(s) previously received benefits while trying to resolve citizenship code "97”). (Section 2505/3331).

4W

9W

     

This person did not cooperate with the Child Support Agency in establishing support for a child who receives Medicaid. (Section 3365 of the Family and Children's Manual.)

41

9T

     

The individual is deceased. (Section 3230 and 3235 of the Family and Children's Manual.)

N/A

61

     

The individual is being terminated at your written request. (Section 3410 of the Family and Children's Manual.)

N/A

76

     

The individual is a resident of a public institution. (Section 3410 of the Family and Children’s Manual.)

N/A

77

     

The individual(s) are terminated due to having failed to provide information which is needed to determine eligibility. (Section 3410 of the Family and Children’s Manual.)

N/A

8L

REASON

TIMELY

ADEQUATE

     

Your eligibility for other pregnancy related services is still pending. (Section 3245 of the Family and Children's Manual.)

N/A

59

REVISED 02/01/11 – CHANGE NO. 03-11

MA CHANGE CODES (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REASON

TIMELY

ADEQUATE

     

You now meet the rules for Medicaid to pay for your Medicare premiums, deductibles, and co-insurance costs. (Section 2130 of the Aged, Blind, and Disabled Manual.)

N/A

86

REASON

TIMELY

ADEQUATE

     

Medicaid will continue to pay your Medicare Part B premium. (Section 2130 of the Aged, Blind, and Disabled Manual.)

N/A

75

REASON

TIMELY

ADEQUATE

     

You remain eligible for Medicaid. (Section 3250 of the Family and Children’s Medicaid Manual.)

1R

5R

REASON

TIMELY

ADEQUATE

     

Now that you are enrolled/receiving Medicare,

Medicaid will not pay your prescriptions. Medicare is responsible for your prescriptions. (See MA 2312 for Laser Notice)

N/A

6X

REASON

TIMELY

ADEQUATE

     

Your Medicaid benefits will be suspended because you are incarcerated. Your Medicaid coverage is limited to payment of medical services related to an inpatient hospital stay. No card will be issued. (DMA Administrative Letter No. 09-08)

N/A

9I

     

Your Medicaid benefits will be suspended because you are in an Institution for Mental Diseases. You will not have any Medicaid coverage during the suspension. No card will be issued. (DMA Administrative Letter No. 09-08)

N/A

9L

REVISED 02/01/11 – CHANGE NO. 03-11

REASON

TIMELY

ADEQUATE

     

Moves from incarceration to IMD:

Your Medicaid benefits will remain in suspension because you are now in an Institution for Mental Diseases. You will not have any Medicaid coverage during the suspension. No card will be issued. (DMA Administrative Letter No. 09-08)

N/A

9P

     

Moves from IMD to incarceration:

Your Medicaid benefits will remain in suspension because you are now incarcerated. Your Medicaid coverage is limited to payment of medical services related to an inpatient stay. No card will be issued. (DMA Administrative Letter No. 09-08)

N/A

9S

     

Your Medicaid benefits were suspended while you were incarcerated. Your Medicaid benefits have now been released from suspension. (DMA Administrative Letter No. 09-08)

N/A

9U

     

Your Medicaid benefits were suspended while you were in an Institution for Mental Diseases. Your Medicaid benefits have now been released from suspension. (DMA Administrative Letter No. 09-08)

N/A

9V

REASON

TIMELY

ADEQUATE

     

Your Medicaid continues because your baby was not born on the due date. (MPW only - Extending a certification period.) (Section 3240 of the Family and Children's Manual.)

N/A

67

     

Your Medicaid will end earlier than you were previously notified because your pregnancy has ended. (MPW only) (Section 3240 of the Family and Children's Manual.)

14

6o

REISSUED 03/01/10 – CHANGE NO. 03-10

MA CHANGE CODES – OTHER (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX

REASON

TIMELY

ADEQUATE

     

You have been accepted into the Community Alternatives Program (CAP). (Section 2280 of the Aged, Blind and Disabled Manual, or Section 3260 of the Family and Children’s Manual.) (N/A to MIC) (Manual notice required for SA, RRF, and MRF)

N/A

72

     

You are no longer receiving Community Alternatives Program (CAP) services. (Section 2280 of the Aged, Blind and Disabled Manual, or Section 3260 of the Family and Children’s Manual.) (N/A to MIC) (Manual notice required for SA, RRF, and MRF)

42

7I

     

You have been involuntarily disenrolled from the PACE program. (Section 2275 of the Aged, Blind, and Disabled Manual).

3P

8P

     

You are eligible for PACE. (Section 2275 of the Aged, Blind, and Disabled Manual).

N/A

8K

     

Other: Use Notice Text to enter the appropriate text. You are limited to three lines with 72 characters per line when using the Notice Text field. You must enter a manual reference if you use this code. (N/A to MIC)

02

50

     

Other: (Manual Notice required).(N/A to MIC)

N/A

73

NOTE: SEE EIS 2500 FOR ALL PACE NOTICES AND CODES.

REISSUED 05/01/09 – CHANGE NO. 03-09

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REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

DSS-8108A

Enter a change code “01” for all Medicaid redeterminations on the
DSS-8125 when completing a review with no changes in benefit. This code can be used when changing data including income, maintenance amount, and/or needs unit. This also includes changes from MIC-1 to MIC-N or from MIC-N to MIC-1 as they are the same benefit for the recipient. Refer to the appropriate transfer code if the aid program/category is changed. EIS will produce a notice to say:

REISSUED 05/01/09 – CHANGE NO. 03-09

REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS (CONT’D)

REISSUED 05/01/09 – CHANGE NO. 03-09

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REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS FOR NON-SSI CASES WITH A CERT. THROUGH DATE OF 12/31/9999.

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

DSS-8108A

Enter a change code “96” for MAABD or HSF redeterminations on the DSS-8125 when completing a review with no change in benefit for Non-SSI cases with the certification through date of 12/31/9999. This code can be used when changing data including income and maintenance amount. Refer to the appropriate transfer code if the aid program/category is changed.

EIS will produce a notice to say:

REISSUED 10/01/09 – CHANGE NO. 01-10

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REDETERMINATION NOTICES WITH NO CHANGES IN BENEFITS FOR NON-SSI CASES WITH A CERT. THROUGH DATE OF 12/31/9999 (CONT’D)

REVISED 10/01/09 – CHANGE NO. 01-10

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DISPOSITION CODES - MEDICAL ASSISTANCE APPROVALS

(MRF CASES REQUIRE A MANUAL NOTICE.)

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

ONGOING APPROVALS (APPLICATION TYPES “1”, “2”, “3”, “4”, “5”, “6”, AND “7”)

REISSUED 05/01/09 – CHANGE NO. 03-09

ONGOING MA APPROVAL NOTICE TEXT (CONT'D)

REISSUED 05/01/09 – CHANGE NO. 03-09

ONGOING MA APPROVAL NOTICE TEXT (CONT’D)

OPEN/SHUT APPROVAL NOTICE TEXT

REVISED 03/01/10 – CHANGE NO. 03-10

MA APPROVAL CODES (CONT’D)

APPROVAL CODES FOR MEDICAID CASES - NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

MA APPROVAL CODES (CONT’D)

REISSUED 07/01/10 – CHANGE NO. 01-11

MA APPROVAL CODES (CONT’D)

REVISED 07/01/10 – CHANGE NO. 01-11

MA APPROVAL CODES

ADD-INDIVIDUALS AND AUTOMATIC NEWBORN COVERAGE APPROVAL CODES (CONT’D)

REISSUED 07/01/10 – CHANGE NO. 01-11

MA APPROVAL CODES (CONT’D)

REISSUED 03/01/010 – CHANGE NO. 03-10

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DISPOSITION CODES - MEDICAL ASSISTANCE DENIALS(G8 IS THE ONLY DENIAL CODE FOR M-SB CASES.)

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REVISED 03/01/10 – CHANGE NO. 03-10

MA INCOME REQUIREMENTS DENIAL CODES (CONT’D)

REVISED 03/01/10 – CHANGE NO. 03-10

MA DENIAL CODES (CONT’D)

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

MA OTHER REQUIREMENTS DENIAL CODES - NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

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

MA OTHER REQUIREMENTS DENIAL CODES (CONT.)

REISSUED 03/01/10 – CHANGE NO. 03-10

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DISPOSITION CODES – MEDICAL ASSISTANCE WITHDRAWALS

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

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MEDICAID TERMINATION CODES

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

DSS-8110A

Based on the “ADEQUATE” or “TIMELY” termination code entered on the DSS-8125, EIS will produce a notice to say:

REISSUED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION CODES (CONT’D) – NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REVISED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION CODES (CONT’D) - NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION CODES (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION CODES (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION CODES (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

PRESUMPTIVE ELIGIBILITY AND MPW

REISSUED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION CODES (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

MA TERMINATION OTHER CODES (CONT’D) NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

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TRANSFERS (AID PROGRAM/CATEGORY)

Transfers to and from MRF, RRF, SAD, SAA, or SCD will not generate an automated notice. A change code is not required for these transfers. MAD to MAA does not require a notice.

NOTE: DO NOT USE THESE CODES FOR NC HEALTH CHOICE. NC HEALTH CHOICE CODES ARE LOCATED IN EIS 4300 PART SIX.

REISSUED 03/01/10 – CHANGE NO. 03-10

REISSUED 03/01/10 – CHANGE NO. 03-10

II.B. (CONT’D)

REISSUED 03/01/10 – CHANGE NO. 03-10

II.C. (CONT’D)

REISSUED 03/01/10 – CHANGE NO. 03-10

II.A. (AAF to MAF CONT’D)

REISSUED 03/01/10 – CHANGE NO. 03-10

REISSUED 03/01/10 – CHANGE NO. 03-10

II.A. (AAF to MAF, MIC, OR MPW CONT’D)

REISSUED 03/01/10 – CHANGE NO. 03-10

II. A. (CONT’D)

ISSUED 03/01/10 – CHANGE NO. 03-10

II. (CONT’D)

REISSUED 02/01/11 – CHANGE NO. 03-11

II. (CONT’D)

REVISED 02/01/11 – CHANGE NO. 03-11

II. (CONT’D)

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