DATE: OCTOBER 21, 2005
SUBJECT: Medicare D and Buy-In
DISTRIBUTION: County Directors of Social Services
Medicaid Eligibility Supervisors
Medicaid Eligibility Staff
The Medicare Prescription Drug Program will be implemented effective January 1, 2006. Medicaid will no longer provide prescription coverage for recipients who have Medicare. It is imperative that EIS contain correct Medicare and Social Security data that matches data found on the State Online Query (SOLQ). If EIS data for a recipient that has Medicare does not match that of SOLQ, the recipient’s data will also be incorrect in the Medicare Drug Program files. This could impact his prescription coverage.
For applications and redeterminations, always use SOLQ data for verification of Medicare, recipient name (first, middle initial, last), date of birth, RSDI or Railroad Retirement Claim Number and/or Social Security Number. A “Z” appears in EIS when a DSS-8125 is keyed with a “Y” in the Medicare field until buy-in is completed. We have identified a number of cases that contain “Z’s” in the Medicare Indicator field in EIS. This indicator means that the individual’s buy-in status is unresolved. Follow procedures below to assure that EIS data is correct for existing cases.
A query has been created in Data Warehouse that will identify all individuals whose Medicare indicators are “Z” and the disposition date is prior to July 1, 2005. Each county must run the query for their county and review the identified cases to determine the correct Medicare status. The county must ensure that demographic information and claim number information in EIS matches SOLQ. Report your findings as indicated in C. below.
Designate an individual with access to Data Warehouse to run the query to identify individuals in your county with a Medicare indicator of “Z.” You may access the query by logging on to the main Data Warehouse screen.
• The query is located in Corporate Documents under the Category titled “State Sanctioned Work First and EIS Queries.”
• The query is titled “Medicare A or B is Z, enter co, Disp earlier than July 05.”
Review SOLQ data for all recipients who appear on the queries. Refer to MA-2410, Medicare Enrollment and Buy-In, VII.D. for assistance. Information regarding effective dates of Medicare coverage is found on page 3 of the SOLQ. You must verify whether the individual has Medicare and that demographic information in SOLQ matches that contained in EIS.
• First name, middle initial, last name
• Social Security Number
• Date of Birth
Counties must report to DMA Claims Analysis only cases that need correction to the Medicare or RSDI fields. For reporting purposes, we recommend that you format information from the spreadsheets like the attached Example.
No later than December 1, 2005 forward your report to:
DMA Claims Analysis Unit
2501 Mail Service Center
Raleigh, NC 27699-2501
If you are unable to download the query to a spreadsheet or can’t format the spreadsheet like the example please:
• Write the changes on the query, or,
• Add an additional column to the spreadsheet and list the changes, and
• Send to the address above.
Claims Analysis staff have requested that you be aware of the following concerns:
If you have any questions regarding this policy, please contact your Medicaid Program Representative.
(This material was researched and written by Jon York, Field Staff Supervisor, Medicaid Eligibility Unit)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.