Family and Children's Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER NO. 01-12, Premium Payment Screen

DATE: January 5, 2012

SUBJECT: PREMIUM PAYMENT SCREEN

DISTRIBUTION: COUNTY DIRECTORS OF SOCIAL SERVICES

INCOME MAINTENANCE DIRECTORS

MEDICAID CASEWORKERS AND SUPERVISORS

NCHC CASEWORKERS AND SUPERVISORS

I. BACKGROUND

Effective January 17, 2012, the NC Health Choice Premium Payment Screen will be available in the Eligibility Information System (EIS) for the caseworker to determine if the premium payments for NC Health Choice Optional Extended Coverage (MIC-L) have been made. The caseworker will be able to view the premium payment date and verify premium payments for recipients who were approved for MIC-L with benefit months beginning with October 1, 2011.

The NC Health Choice Premium Payment Screen is located on the EIS Menu (Inquiry). To access the screen, enter the selection as “PP” and key the Medicaid Individual Number (MID).

The Division of Medical Assistance (DMA) will begin manually terminating all Extended Coverage cases and/or individuals who failed to make premium payments by the established deadline. DMA will continue to automatically terminate cases and/or individuals at the end of the 12 month certification period who are approved for Optional Extended Coverage and continue making premium payments for the entire 12 months. Notices will be sent to recipients to inform them of the reason for termination.

Refer to Family and Children Medicaid 3255 (NC Health Choice) for additional policy information.

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II. RESPONSIBILITIES OF THE INCOME MAINTENANCE CASEWORKER

A. The caseworker must verify whether premiums were paid for all individuals who were approved for Optional Extended Coverage and who has now reapplied and found eligible to receive in another aid program. To verify premiums, the caseworker must complete the following steps:

1. From the EIS Menu (Inquiry) Screen, Key “PP” and the Medicaid Individual Number (MID). Then press enter.

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2. The following information will display:

a) Individual ID Number

b) Recipient Name

c) Recipient Date of Birth

d) Case ID Number

e) County Number

f) Certification Period

g) Payment Data Created

h) Premium Payment End Date

i) Monthly Premiums Amount

j) Date Payment Post

3. The Premium Payment Screen will display each month in which premiums were received, the amount received, the date premium payments were posted, and a code representing the DMA worker who entered the information. The caseworker would use the last month that a premiums payment was received to determine the paid-to-date.

Example: If a payment amount for 12/31/2011 was the last month entered, this indicates that the recipient has paid premiums through 12/31/2011.

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4. If each month displays a zero amount, the recipient was approved for the Optional Extended Group but no premiums have been made.

Please Note: The caseworker can view another individual by entering “PP” and the Medicaid Individual Number (MID) without exiting the screen.

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5. If the caseworker enters an Medicaid Individual Number (MID) for a recipient who was not approved for Optional Extended Coverage, the Premium Payment Screen will list the individual information at the top of page but the message “Individual Is Not In Extended Coverage Group” will display.

B. Key “PF2” to Exit.

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If you have any questions regarding this information, please contact your Medicaid Program Representative.

Sincerely,

Craigan L. Gray, MD, MBA, JD

Director

(This material was researched and prepared by Brenda Gooch, EIS Program Consultant, DMA/EIS Unit.)