NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2254

------------------------------------------------------------------------------

------------------------------------------------------------------------------

DHHS Home Page NC DHHS On-Line Manuals
View Manual in PDF      DHHS Manual Home Manual Admin Letters Change Notices Archive Search Index Help Feedback

EIS 2254 – APPROVING M-AF AND M-RF NEW APPLICATIONS OR REAPPLICATIONS


I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125 AND DSS-8126's.

Iv. OUTPUTS

V. AUTOMATED NOTICES


Previous PageTable Of ContentsNext Page

EIS 2254 – APPROVING M-AF AND M-RF NEW APPLICATIONS OR REAPPLICATIONS

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

Top Of Page

I. GENERAL INFORMATION

E. When approving a case in suspended status due to incarceration, key the living arrangement code on the approval that indicates the suspension. The next day after the approval processes, change the living arrangement code to the appropriate code on the DB/PML screen for the months of eligibility prior to incarceration. EIS automatically enters the Carolina Access exempt number for suspension at approval based on the living arrangement code entered.

    F. After the approval processes overnight, use the DB/PML function when:

      1. Authorizing Medicaid benefits under a different aid program/ category from the month of application through the month of disposition.

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

I.F. (CONT’D)

      2. Authorization for all retroactive months cannot be entered on the DSS-8125.
      3.
Changing the living arrangement from suspension to another living arrangement code for months of eligibility prior to incarceration for an application approved in suspended status. EIS automatically deletes the Carolina Access exempt number for suspension when the living arrangement code is changed.
      4. Changing the living arrangement from suspension to another living arrangement for the month of release from incarceration or IMD placement and for any succeeding months. EIS automatically deletes the Carolina Access exempt number for suspension when the living arrangement code is changed.

      Refer to EIS 3105, Deductible Balance/Patient Monthly Liability Transaction.

    G. There are two types of applications, one part and two part. A one part application can be for retroactive coverage only or ongoing coverage only. A two part application is for retroactive and ongoing coverage.

    H. Each piece of a two part Medicaid application may be dispositioned (approved/denied/withdrawn) regardless of whether the other part is being dispositioned.

    I. New applications and reapplications are dispositioned exactly the same way unless you are approving a reapplication against an ongoing case. If this is true, old case termination date is required.

    J. When an individual reapplies for both AAF and MAF against the same closed case ID and the AAF application is approved first, the MAF application must be administratively denied. If the applicant is eligible for MAF prior to the AAF eligibility, complete an administrative DSS-8124 application as “NEW” under MAF and approve by completing the DSS-8125.

      If these procedures are not followed, the system will require old case termination date. If entered, the ongoing AAF case will be closed.

    K. When both parts of a two-part application are dispositioned on the same day and one part is denied or withdrawn, the denial or withdrawal must be keyed first. Otherwise, the DSS-8124 re-entry will delete the DSS-8125 approval.

    L. When each part of a two-part application is dispositioned on a different day and the retroactive part is dispositioned last, the current case data will not be updated. The retroactive eligibility can be viewed by using the “IE” inquiry selection.

    M. A DMA-2041 is required when an applicant/recipient has health and/or accident insurance.

      Refer to EIS 3350, Instructions for Third Party Health and Accident Resources Information (DMA-2041).

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

Top Of Page

II. COMPLETING THE DSS-8125

    If a numeric field requires less digits than spaces available, precede with zeroes.

    A. CASE IDENTIFYING INFORMATION

      1. Enter the CASEHEAD/PAYEE NAME for filing purposes.
      2. Enter the COUNTY NAME.
      3. Do not enter the CASE ID. The CASE ID is brought forward from the application and may not be changed.
      4. Enter your WORKER NUMBER.
      5. Enter your COUNTY NUMBER.
      6. Enter the COUNTY CASE NUMBER.
      7. Enter the DISTRICT NUMBER.
      8. Do not enter COUNTY REASSIGNMENT NEW COUNTY.
      9. Do not enter COUNTY REASSIGNMENT EFFECTIVE DATE.
      10. Enter the AID PROGRAM/CATEGORY. If a change is needed, it must be entered on the Application Turnaround before approval is keyed.
      11. Do not enter CASEHEAD/PAYEE NAME. Refer to EIS-3101 for making CASEHEAD/PAYEE changes.
      12. If the applicant is not in long term care, enter:

        ADDRESS – Refer to EIS 4050, Mailing Address Appendix, for complete instructions to enter address correctly, if different than indicated on the Application Turnaround. Failure to enter the address properly can result in delay of delivery of notices and cards to the recipient.

      13. If the applicant is in long term care, enter:
        a. ADDRESS - For a long term care application, refer to EIS 4050, Mailing Address Appendix, for complete instructions to enter the facility address correctly, if different than indicated on the Application Turnaround.
        b. If you want the DMA-5016 mailed to a different address than the case address, enter the facility code. (See EIS 1063 for instructions on determining the facility code.)

        EIS mails the Medicaid card and DMA-5016 to the case address if a facility code is not entered.

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

II. A. (CONT’D)

        EIS mails the Medicaid card to the case address and the DMA-5016 to a different address if a facility code is also entered.

      14. Enter the CITY, STATE, and ZIP CODE if different than indicated on the Application Turnaround. See EIS 4050, Mailing Address Appendix, to determine the correct abbreviations.
      15. Enter the casehead/payee's three-digit area code and
      seven-digit PHONE NUMBER if applicable.
      16. Enter a VERIFICATION INDICATOR to indicate if all eligibility factors have been verified.

              “Y” = YES “N” = NO

      17. Enter SUBSTITUTE PAYEE CODE and NAME if a substitute payee has been appointed to the case. See the Codes Appendix to determine the appropriate substitute payee code.
      18. Do not enter a CHANGE CODE.
      19. Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice for MAF. Do not enter for MRF.

        Always override the automated notice when:

        a. You use the DB/PML function to issue any benefits.
        b. The only individual in the case is in long term care and has a deductible.
        c. The only individual in the case is in long term care and you cannot enter all Patient Monthly Liabilities on the DSS-8125.

    B. APPLICATION DATA

      1. Enter the APPLICATION NUMBER from the Application Turnaround.
      2. If approving ongoing coverage, enter the ONGOING DISPOSITION REASON and DATE. See the Codes Appendix to determine the appropriate disposition reason code; and/or
      3. If approving retroactive coverage, enter the RETRO DISPOSITION REASON and DATE. See the Codes Appendix to determine the appropriate disposition reason code. It is very important to enter the correct disposition code. Unless overridden, an automated notice is produced based on the reason entered on the DSS-8125. The disposition reason code determines the text of the notice. See AUTOMATED

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

II. B. 3. (CONT’D)

        NOTICES at the end of this section for more information regarding the automated notices.

        a. If the notice is overridden, the DISPOSITION DATE must be the same date the approval notice is mailed to the recipient.
        b. If all individuals are not eligible for the same time periods, enter the ONGOING DISPOSITION REASON and DATE. Complete a DB/PML transaction to authorize retroactive benefits. See EIS-3105, Deductible Balance/Patient Monthly Liability Transaction.
        c. If individual(s) need to be added, see EIS 2257,
        Add-An-Individual Application, for instructions on how to add individuals.
      4. If approving both parts, the ONGOING and RETRO DISPOSITION REASONS and DATES must be entered.

    C. CASE TERMINATION DATA

      1. If approving the case in terminated status (Open/Shut), enter CASE TERMINATION REASON and DATE. The date must be the last day of the CERTIFICATION THRU month. See the Codes Appendix to determine the appropriate termination reason code.

              OR

        If approving retroactive coverage only (for a one or two part application), enter CASE TERMINATION REASON and DATE. The date must be the last day of the month before the month of application.

      2. Enter the OLD CASE TERMINATION REASON and DATE if approving a reapplication, and the case you are reapplying against is still open.

    D. DO NOT ENTER PAYMENT DATA.

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

II. (CONT'D)

    E. MEDICAID DATA

      For approving ongoing only or retroactive and ongoing at the same time.

      1. Enter MEDICAID STATUS “A”.
      2. Enter MEDICAID EFFECTIVE DATE.
        a. This date must be the same for all individuals. If the date is different for some individuals, use the DB/PML transaction to request retroactive coverage. See EIS-3105, Deductible Balance/Patient Monthly Liability Transaction for instructions.
        b. If MEDICAID CLASS is “F” or “O”, the MEDICAID EFFECTIVE DATE can be any day of the month.
        c. If approving ongoing coverage:
          (1) This date must not be before the application month.
          (2) If the Medicaid class is “D”, the date must not be prior to 10/01/05.
          (3) This date must fall within the certification period.
          (4) This date must be before or the same as the ongoing processing month.

            If you are reopening a case that at the time of termination was suspended due to incarceration or residence in an Institution for Mental Disease (IMD), the Medicaid Effective Date must be the ongoing processing month. Authorize prior months on the DB/PML screen.

            Refer to EIS-3105, DB/PML Transaction Instructions for Medicaid Application Approvals for completing authorization on the DB/PML screen.

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

II. E. (CONT'D)

          (5) Enter an INDIVIDUAL TERMINATION DATE under Individual Data if any individuals are not eligible for ongoing coverage.
          (6) This date must be before or the same as CASE TERMINATION DATE if the case is approved in terminated status (Open/Shut).
        d. If approving retroactive coverage with ongoing:
          (1) This date may be up to three months before the month of application if there is no break in coverage. If there is a break in coverage, use the RETRO MA 1 and 2 fields.
          (2) This date must be before the CERTIFICATION THRU month.
          (3) This date must be before or the same as the ongoing month.
          (4) This date must be before or the same as the CASE TERMINATION DATE if the case is approved in terminated status (Open/Shut).
          (5) If the MEDICAID EFFECTIVE DATE is before the CERT FROM DATE, it must be before the application month and be any day of the month. If the MEDICAID CLASS is “F” or “O”, the MEDICAID EFFECTIVE DATE can be any day of the month.
          (6) If the Medicaid Class is “D”, this date must not be prior to 10/01/05.
      3. Enter the CERTIFICATION FROM DATE. For ongoing only or retroactive with ongoing, the CERTIFICATION FROM DATE must be the first day of the month.
      4. Enter the CERTIFICATION THRU DATE.
        a. This date may be up to six months from the CERTIFICATION FROM DATE.
          NOTE: If the Medicaid Class is “C”, “D”, or MAF-BCCM (Breast and Cervical Cancer Medicaid), this date may be up to 12 months from the CERTIFICATION FROM DATE.

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

II. E. 4. (CONT'D)

        b. If the CASE TERMINATION DATE is entered, the CERTIFICATION THRU DATE must be the month and year of termination.

          NOTE: IF THE APPLICATION PENDS BEYOND THE FIRST SIX MONTHS, AND BOTH CERTIFICATION PERIODS ARE BEING DISPOSITIONED, ENTER THE FIRST CERTIFICATION PERIOD. ENTER THE SECOND SIX MONTHS CERTIFICATION ON A DSS-8125 TO BE SUBMITTED THE FOLLOWING WORK DAY.

        c. If approving an alien case for emergency services only, the CERTIFICATION THRU DATE must be the day the emergency services end as authorized by the Division of Medical Assistance.

          NOTE: EMERGENCY SERVICES ARE NOT APPLICABLE TO MRF OR MAF-D.

      5. Enter MEDICAID CLASS.
      6. Enter “D” or “P” in the DEDUCTIBLE BALANCE/PATIENT MONTHLY LIABILITY (DB/PML) field if applicable. If the MEDICAID EFFECTIVE DATE is any day other than the first day of the month, then the DB/PML is required.
      7. Enter the DB/PML AMOUNT if DB/PML Type is entered. The AMOUNT may be all zeroes.

        NOTE: DB/PML type and amount not applicable for Medicaid Class “D”, Family Planning.

REVISED 10/01/96 - CHANGE NO. 2-96

II. (CONT'D)

    F. RETRO MA 1 AND 2

      Complete RETRO MA 1 and 2 to authorize Medicaid prior to the month of application if the MEDICAID EFFECTIVE DATE does not cover all retroactive months to be authorized. If you are completing both RETRO MA 1 and 2, the earliest retroactive period must be entered in RETRO MA 1. For example, if the recipient is eligible for retroactive months 04/90 and 06/90, 04/90 must be entered in RETRO MA 1.

      1. RETRO MA 1
        a. Enter the AID PROGRAM/CATEGORY under which the retroactive coverage is given.
        b. Enter AUTHORIZATION FROM and AUTHORIZATION THRU dates.
          (1) The AUTH FROM DATE may be up to three months before the month of application if there is no break in coverage.
          (2) The AUTH THRU DATE must be the last day of the month unless RETRO MED CLASS 1 is “F” or “O”; in this case the date can be any day of the month.
        c. Enter MEDICAID CLASS for the retroactive period.
        d. Enter “D” or “P” in DEDUCTIBLE BALANCE/PATIENT MONTHLY (DB/PML) if applicable for the retroactive period.
        e. Enter DB/PML AMOUNT if DB/PML Type is entered.
        f. If a PML is entered and you need the DMA-5016 to go to a different facility than the facility indicated in the address section, enter the three character facility code for the facility which is to receive the DMA-5016 for the Retro MA 1 period. (See EIS 1063 for instructions on determining the facility code.)
      2. RETRO MA 2

        Do not enter RETRO MA 2 unless RETRO MA 1 is entered. If there is a break in the retroactive coverage, complete RETRO MA 2.

REVISED 10/01/96 - CHANGE NO. 2-96

II. F. 2. (CONT'D)

        a. Enter the AID PROGRAM/CATEGORY under which the retroactive coverage is given.
        b. Enter AUTHORIZATION FROM and AUTHORIZATION THRU dates.

          The RETRO MA 2 FROM and THRU DATES must be after the RETRO MA 1 THRU DATE.

          (1) The AUTH THRU DATE may be up to three months before the month of application if there is no break in coverage.
          (2) The AUTH FROM DATE must be the last day of the month unless RETRO MED CLASS 1 is “F” or “O”; in this case the date can be any day of the month.
        c. Enter MEDICAID CLASS for the retroactive period.
        d. Enter “D” or “P” DB/PML Type if applicable for the retroactive period.
        e. Enter DB/PML AMOUNT if DB/PML Type is entered.
        f. If a PML is entered and you need the DMA-5016 to go to a different facility than the facility indicated in the address section, enter the three character facility code for the facility which is to receive the DMA-5016 for the Retro MA 2 period. (See EIS 1063 for instructions on determining the facility code.)

REVISED 07/01/10 - CHANGE NO. 01-11

II. (CONT'D)

    G. EARNED INCOME (IF ZERO, LEAVE BLANK)

    Do not enter for MAF-BCCM (Breast and Cervical Cancer Medicaid).

      All fields must be in dollars and cents.

      1. Enter the GROSS EARNED INCOME. GROSS EARNED INCOME must be entered if any of the following are entered: WORK EXPENSES, CHILD/ADULT CARE, DISREGARD, or NET EARNED INCOME.
      2. Enter the WORK EXPENSES.
      3. Enter CHILD/ADULT CARE.
      4. Enter the DISREGARD.
      5. Enter the NET EARNED INCOME.
      6. Do not enter GRANT RECOUPMENT CODE, AMOUNT or END DATE.

    H. UNEARNED INCOME (IF ZERO, LEAVE BLANK)

      All fields must be in dollar and cents amounts.

      1. Enter the RSDI AMOUNT. If entered, RSDI CLAIM NUMBER is required.
      2. Enter the TOTAL NET UNEARNED INCOME.
    I. Enter the OTHER UNEARNED INCOME.
        1. The amount must be dollars and cents.
        2. The amount must be included in the TOTAL NET UNEARNED INCOME.
      J. Enter the TOTAL NET UNEARNED INCOME.
      1. The amount must be dollars and cents.
        2. The amount must be the same as the RSDI AMOUNT plus OTHER UNEARNED, if RSDI and OTHER UNEARNED INCOME is entered.
        3. TOTAL COUNTABLE MONTHLY INCOME must also be entered.

REISSUED 07/01/10 - CHANGE NO. 01-11

    K. NEEDS

    Do not enter for MAF-BCCM (Breast and Cervical Cancer Medicaid).

      1. Enter the MAINTENANCE AMOUNT. The amount must be dollars and cents.
      2. Do not enter AMBULATION CAPACITY.
      3. Do not enter DOMICILIARY RATE.
      4. Enter TOTAL COUNTABLE MONTHLY INCOME. The amount must be in dollars and cents. TOTAL COUNTABLE MONTHLY INCOME must be entered if TOTAL NET UNEARNED INCOME is entered. The TOTAL COUNTABLE MONTHLY INCOME must be the same as or more than the TOTAL NET UNEARNED INCOME.

    L. SPECIAL DATA

      1. Enter the FOOD STAMP NUMBER if known.
      2. Enter a STEPPARENT INDICATOR if known. This is an optional field. Refer to the Codes Appendix to determine the appropriate code.
      3. Do not enter GRANDFATHER STATUS CODE and DATE.
      4. Mark “YES” or “NO” for VA PAYMENT.
      5. Enter SPECIAL REVIEW TYPE and DATE if needed. See the Codes Appendix to determine the appropriate special review code and date.
      6. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.
      7. Enter SPECIAL USE CODE and DATA if needed. See the Codes Appendix for special use code and date.

    M. SPECIAL COVERAGE GROUP DATA

      NOTE: FOR M-AF ONLY; DO NOT ENTER FOR MRF or MAF-D, Family Planning.

      1. Enter the correct code in the SPECIAL COVERAGE GROUP CODE field if applicable. Refer to EIS 4000, codes appendix for valid codes.
      2. Enter the six digit SPECIAL COVERAGE GROUP BEGIN DATE.
        a. The BEGIN DATE must be the first day of the month.
        b. The BEGIN DATE may be no more than three months prior to the month of application.

REISSUED 07/01/10 - CHANGE NO. 01-11

II. M. (CONT'D)

      3. If an Open/Shut, enter the date coverage ends in SPECIAL COVERAGE GROUP END DATE. This must be the last day of the month.
      4. Do not enter SPECIAL COVERAGE GROUPS 2 and 3.
      5. Do not enter SPECIAL NEEDS.

    N. 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 your DSS-8125 when submitting to Data Entry for keying.

      1. 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.

      2. Secondary Notice Code

        This code may be used in addition to the disposition code at approval time only. You may use it in situations when additional information is needed. Refer to Secondary Notice Codes in the Codes Appendix.

      3. Notice Text

        This section may be used to provide additional information to the applicant, when a Secondary Notice Code is not applicable.

        Note: If you are approving both parts of a two-part application at the same time, and you use two different disposition codes, you cannot enter the Secondary Notice Code or Notice Text.

    O. INDIVIDUAL DATA

      The casehead name and the individual(s) included in the case will be brought forward from the case or the application and cannot be changed. When a DSS-8125 is keyed, EIS reads the common name database to retrieve the individual assigned to the case id with a casehead/payee status of “P”. If any of the individual data is incorrect, use the NAME CHANGE screen to make the appropriate correction(s).

REISSUED 07/01/10 - CHANGE NO. 01-11

II. O. (CONT’D)

      Enter the following data:

      1. Enter INDIVIDUAL TERMINATION DATE if not eligible in the ongoing case.

          NOTE: FOR MAF-D, FAMILY PLANNING, THIS DATE MUST BE THE APPLICATION DATE.

          NOTE: AT LEAST ONE INDIVIDUAL IN THE CASE MUST REMAIN ACTIVE.

        a. This date must not be later than the last day of the month prior to the ongoing month.
        b. Do not enter if there is only one individual in the case.
        c. Do not enter if DATE OF DEATH is entered.
        d. This date must be the last day of the month of eligibility.
        e. This date may be the date of application. This should only be entered if the individual is on the application in error.
        f. This date may be the last day of the month before the month of application.
      2. Do not enter CASE STATUS. EIS generates.
      3. Enter the RSDI CLAIM NUMBER if the individual has Social Security benefits or Medicare coverage.
      4. Enter “Y” or “N” in MEDICARE A to indicate whether or not the individual has Medicare A. If “Y” is entered, the RSDI CLAIM NUMBER must be entered.

        Enter “N” for MAF-D, Family Planning. “Y” is not allowed.

      5. Enter “Y” or “N” in MEDICARE B to indicate whether or not the individual has Medicare B. If “Y” is entered, the RSDI CLAIM NUMBER must be entered.

        Enter “N” for MAF-D, Family Planning. “Y” is not allowed.

      6. Enter a FAMILY STATUS of “P”, “C” or “O” as appropriate. See the Codes Appendix to determine the appropriate family status code.

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

II. O. (CONT'D)

      7. Enter a LIVING ARRANGEMENT CODE. The code must be the same for all individuals. See the Codes Appendix to determine the appropriate living arrangement code.
      8. Enter a SPECIAL REPORT code if applicable, for M-AF only. See the Codes Appendix to determine the appropriate special report code.
      9. Do not enter JOBS/WORK REGISTRATION/EXEMPTION.
      10. Enter SPECIAL USE DATA CODE and DATA if needed. See the Codes Appendix to determine the appropriate special use code and dates.
      11. Enter REFUGEE STATUS CODE and U.S. ENTRY DATE (in MMCCYY format), if applicable. For MRF, all individuals must have the same ENTRY DATE and all individuals must not have been in the country for more than 8 months. See the Codes Appendix to determine the appropriate Refugee Status Code.
      12. Enter DATE OF DEATH if applicable.
        a. If entered, CASE TERMINATION REASON and DATE are required if this is the only individual on the case.
        b. The DATE OF DEATH must be before or the same as the CASE TERMINATION DATE.
        c. The DATE OF DEATH must be before or the same as the current date.
        d. Do not enter an INDIVIDUAL TERMINATION DATE if DATE OF DEATH is entered.
      13. Enter the two digit CITIZEN/ID code and the date (in MMDDCCYY format), if applicable. Enter Citizen/ID codes for refugees, asylee, Cuban/Haitian status, Amerasian, trafficking victim or special immigrant. See the Codes Appendix to determine the appropriate Citizen/ID code and what the date reflects.
      14. Enter Alien ID number, if applicable. Key only the numeric parts of the Alien ID number. Do not enter the alpha “A”.
      15. Enter the RELATIONSHIP TO PAYEE code. See Codes Appendix to determine the appropriate code.
      16. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.

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

II. O. (CONT'D)

      17. Do not enter WORK EXPERIENCE.
      18. Do not enter GROSS EARNED INCOME.
      19. Do not enter WORK EXPENSES.
      20. Do not enter CHILD/ADULT CARE.
      21. Do not enter NET EARNED INCOME.
      22. Do not enter EDUCATIONAL LEVEL.
23. Enter type and date of EDUCATION provided. (Not allowed for MRF.) Refer to EIS 4100, Community Care of North Carolina, for more information. These fields are not required for an individual who has a suspended living arrangement code.
      24. Enter “Y” or “N” for ISSUE CARD. If the individual has an annual Medicaid card from a prior time, enter “N”. A new card will not be issued. If the individual states they do not have an annual Medicaid card enter “Y”. A new card will be produced the night the approval processes and mailed the following workday.
      25. Enter COMMUNITY CARE OF NORTH CAROLINA (CCNC) provider or exempt number. (Not allowed for MAF-D (Family Planning), or MRF. Refer to EIS 4100, Community Care of North Carolina, for more information.

        EIS automatically populates the CCNC field with an exemption code based on the living arrangement code entered for an individual suspended due to incarceration or suspended due to residence in an Institution for Mental Disease.

      26. Complete the DSS-8126, Continuation Sheet, using instructions in II. K. as a continuation of the DSS-8125 to enter individual data when there is more than one person. If there are five or more individuals, complete a second DSS-8126(s). A sample of the DSS-8126 is located at the end of this volume.

    P. SIGNATURES AND DATE

      1. Enter DATE COMPLETED.
      2. Sign the DSS-8125 in the WORKER'S SIGNATURE field.
      3. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field

Top Of Page

III. KEY THE DSS-8125 AND DSS-8126's.

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

Top Of Page

Iv. OUTPUTS

    When the DSS-8125 has processed successfully, the following are received:

    A. BENEFITS ISSUED

      An annual Medicaid identification card for each individual on the case is produced the night the approval processes and mailed to the recipient the following workday.

    B. CASE PROFILE

      A Case Profile is produced the night the approval processes and is mailed to the county the following workday.

    C. APPLICATION TURNAROUND DOCUMENT

      If one part of a two part application is approved, an Application Turnaround Document is received for the second part of the application still pending.

    D. DMA-5016 (Patient Liability Notification)

      The automated DMA-5016 is created after the action processes in EIS and is mailed the next workday for the current and retro periods, if applicable, to the appropriate facility indicated by the code(s) or address entered.

    E. CASEWORKER SUPERVISOR REPORT

      The application approval is reported on the Caseworker Supervisor Report. The number of approvals completed is determined from the WORKER NUMBER.

    F. MAF-D APPLICATIONS DENIED/WITHDRAWN TOTALS

EIS produces a monthly report that indicates the number of MAF-D (Family Planning) denial and withdrawal dispositions keyed in the previous month including a year-to-date total. The report lists the denial/withdrawal codes used and the number of cases using that code. The report name is “DHRWDB MAF-D APPS DENIED/WITHDRN” and is available on the 5th workday of the month.

Top Of Page

V. AUTOMATED NOTICES

    A. An automated notice (DSS-8108A) is produced for each MAF approval the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE.

      NOTE: MRF notices are not automated. You must complete a manual notice.

    B. The DISPOSITION REASON CODE, the SECONDARY NOTICE CODE, and the NOTICE TEXT entered on the DSS-8125 determines the text of the notice.

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

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

V. (CONT'D)

    D. The date of the automated notice is the next State workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient. A copy of the notice is mailed to the authorized representative or BCCCP coordinator (for Breast and Cervical Cancer Medicaid cases) if the Authorized Representative's Name and Address fields are entered on the DSS-8125.

    E. 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 2304 for more information regarding the Notice Register Report.

Previous PageTop Of PageNext Page



 


View Manual in PDF      DHHS Manual Home Manual Admin Letters Change Notices Archive Search Index Help Feedback