NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 1054

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

INDIVIDUAL INQUIRY

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

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 1054 - INDIVIDUAL INQUIRY


I. GENERAL INFORMATION

II. SCROLLING THROUGH THE CASE INDIVIDUALS (CI)

III. CURRENT INDIVIDUAL DATA (ID)

IV. INDIVIDUAL PROFILE (IP)

V. INDIVIDUAL MEDICAID ELIGIBILITY (IE)

vi. INDIVIDUAL MEDICARE A/B DATA (MB)

VII. INDIVIDUAL MEDICARE C (MC)

VIII. INDIVIDUAL MEDICARE D ENTITLEMENT DATA (MD)

IX. INDIVIDUAL MEDICARE D Enrollment DATA (ME)

X. PACE/MANAGED CARE HISTORY INQUIRY (MI)

XI. ASSETS TRANSFER INQUIRY/UPDATE (AT)


Previous PageTable Of ContentsNext Page

EIS 1054 - INDIVIDUAL INQUIRY

REISSUED 10/01/09 - CHANGE NO. 01-10

Top Of Page

I. GENERAL INFORMATION

Top Of Page

II. SCROLLING THROUGH THE CASE INDIVIDUALS (CI)

REVISED 10/01/09 – CHANGE NO. 01-10

REISSUED 10/01/09 – CHANGE NO. 01-10

II. (CONT’D)

REVISED 10/01/09 – CHANGE NO. 01-10

II. (CONT’D)

Top Of Page

III. CURRENT INDIVIDUAL DATA (ID)

REVISED 10/01/08 - CHANGE NO. 01-09

III. (CONT’D)

REVISED 10/01/08 - CHANGE NO. 01-09

III. (CONT’D)

REVISED 10/01/09 - CHANGE NO. 01-10

III. (CONT’D)

Top Of Page

IV. INDIVIDUAL PROFILE (IP)

    To view the individual’s sanction information, Job Bonus data, Work First months used, Benefit Diversion, and the current Medicaid eligibility period, enter IP in the SELECTION field and the ten digit Individual ID in the KEY field. Press ENTER. The following screen displays:

REISSUED 10/01/09 - CHANGE NO. 01-10

IV. (CONT’D)

    This screen displays the following Individual data:

    A. IVD Sanc Beg/End Date – These fields reflect the begin and end dates of the IVD sanction period.

    B. MRA SANC Beg/End Date – These fields reflect the begin and end dates of the MRA sanction period.

    C. Work First Job Bonus Beg/End Date – These fields reflect the begin and end dates of the Work First (AAF) Job Bonus period.

    D. Medicaid Job Bonus Beg/End Date – These fields reflect the begin and end dates of the Medicaid (MAF) Job Bonus period.

    E. Status in Case – This code reflects if the individual is a recipient or a non-recipient in the case.

    F. Teen Parent – Refer to the Work First Appendicies.

    G. Tot 12 Mths Used - Refer to the Work First Appendicies.

    H. Tot 24 Mths Used - Refer to the Work First Appendicies.

    I. Tot 60 Mths Used – Refer to the Work First Appendicies.

    J. Tot Mths Xfer In – Refer to the Work First Appendicies.

    K. Benefit Diversion – Refer to the Work First Appendicies.

REVISED 05/01/09 - CHANGE NO. 03-09

IV. (CONT’D)

    L. Family Violence - Refer to the Work First Appendicies.

    M. Cross Ref Ids – This shows other Individual Ids under which the same person is or was receiving Medicaid benefits.

    N. Special Use – This code relects if Individual Special Use data has been entered.

    O. Current IE – Refer to V. A. below for explaination of the fields.

    P. HMO Pvdr – Indicates the current HMO Provider number.

    The current IE segment on this screen will change when the Individual’s Medicaid eligibility period changes on the IE screen.

Top Of Page

V. INDIVIDUAL MEDICAID ELIGIBILITY (IE)

    To view the individual's current and historical Medicaid eligibility periods, enter “IE” in the SELECTION field and the ten digit Individual ID in the KEY field. Press ENTER. The following screen appears.

    A. The screen displays IE segments. For each period of eligibility, you see:

      1. Hist-From. This is the certification from date for the period of eligibility.
      2. Auth-From. This is the authorized from date for the period of eligibility.
      3. Hist-Thru. This is the authorized thru date or certification thru date for the periods.
      4. PGM CAT. This is the aid program/category under which Medicaid was authorized.
      5. MED-CLS. This is the classification under which Medicaid was authorized.

REVISED 05/01/09 – CHANGE NO. 03-09

V. A. (CONT'D)

      6. SSI ST. This is a “Y” or “N” indicator to show whether the individual receives SSI benefits or not.
      7. CO. This is the county in which Medicaid was authorized.
      8. PAY TP. The payment type for the case.
      9. Case-ID. The Case ID under which the benefit was issued.
      10. LIV. The case living arrangement code.
      11. DB/PML CD AMT. The codes D or P indicating Deductible Balance or Patient Monthly Liability and the amount of the Deductible Balance or Patient Monthly Liability.
      12. Spec. Cov. Indicates Community Alternative Program (CAP) coverage.
      13. SUBPGM CDE FPL. Subprogram Code (for example, Money Follows The Person or Health Coverage for Working Disabled) and Federal Poverty Level. Refer to the Codes Appendix for valid codes.
      14. AMB. This is the Ambulation Capacity code.
      15. SN. This is the Special Needs code.
      16. PCHP. Piedmont Cardinal Health Plan – A “P” indicator indicates the individual is enrolled with the PCHP.
      17. Provider Num. Carolina Access Provider Number or Exemption Code.
      18. AUTO. A Yes or No indicator to indicate if the Managed Care Provider was automatically assigned to the recipient.
      19. RSN. The reason the recipient changed provider.
      20. DIST. Distance to the provider.

    B. A new Individual Medicaid Eligibility segment is created every time the Medicaid Effective Date is updated.

Top Of Page

vi. INDIVIDUAL MEDICARE A/B DATA (MB)

    To view an individual’s Medicare A/B data, enter “MB” in the SELECTION field and the ten digit Individual ID in the KEY field. Press ENTER. The following screen appears:

REVISED 10/01/08 – CHANGE NO. 01-09

VI. (CONT’D)

    Press “PF4” to view Medicare D ENTITL Data (MD), or

    Press “PF6” to view Medicare C Data (MC).

    Press “PF7” to page back.

    Press “PF8” to page forward.

    Press “PF10” to view Medicare D ENROLL Data (ME)

    The screen displays:

    A. Individual Data

      1. Recipient ID
      2. Recipient Name
      3. Social Security Number

    B. Medicare A Data

      1. Medicare A Status Code
        a. Y - Yes, populated by MMA monthly response file
        b. N - No, populated by MMA monthly response file and by the county using information entered into the DSS-8125 screen at application approval
        c. Z - Yes, populated by the county entering “Y” for Medicare A on the DSS-8125
      2. RSDI Claim Number
        a. Populated by claim number keyed on the DSS-8125 by the county, or
        b. Populated from the MMA monthly response file.
      3. Start Date
        a. If a “Y” is entered on the DSS-8125 for Medicare A, (code on Medicare screen for Medicare A is “Z”) EIS does not enter a start date, or

REISSUED 10/01/08 – CHANGE NO. 01-09

VI. B.3. (CONT'D)

        b. If an “N” is entered on the DSS-8125 for Medicare A, and the most current segment is a “Z”, EIS builds an “N” segment with a start date of the 1st day of the next month (using current day and not cycle month), or
        c. EIS uses the start date of Medicare Entitlement from the MMA monthly response file.
      4. End Date
        a. If an “N” is entered on the DSS-8125 for Medicare A, EIS does not enter an end date, or
        b. If the most current data on the MMA monthly response file is “N” for Medicare A Entitlement and the Medicare indicator in EIS is “Y”, the end date is the Entitlement End Date from the MMA response file. A new segment with “N” will have a start date that will be the end date from the response file plus 1 day.
      5. Posted Date

        This is the date the changes from the MMA monthly response file process in EIS, the DSS-8125 processes in EIS, or a correction keyed by the Claims Analysis staff processes in EIS.

      6. Updated By?
        a. MMA - MMA monthly response file
        b. EIS - County
        c. DMA - Claims Analysis Unit

    C. Medicare B Data

      1. Medicare B Status Code
        a. Y - Yes, populated by MMA monthly response file
        b. N - No, populated by MMA monthly response file and by the county using information entered into the DSS-8125 screen at application approval
        c. Z - Yes, populated by the county entering “Y” for Medicare B on the DSS-8125
      2. RSDI Claim Number
        a. Populated by claim number keyed on the DSS-8125 by the county, or

REISSUED 10/01/08 – CHANGE NO. 01-09

VI. B. (CONT'D)

        b. Populated from the MMA monthly response file.
      3. Start Date
        a. If a “Y” is entered on the DSS-8125 for Medicare B, (code on Medicare screen for Medicare B is “Z”) EIS does not enter a start date, or
        b. If an “N” is entered on the DSS-8125 for Medicare B, and the most current segment is a “Z”, EIS builds an “N” segment with a start date of the 1st day of the next month (using current day and not cycle month), or
        c. EIS uses the start date of Medicare Entitlement from the MMA monthly response file.
      4. End Date
        a. If an “N” is entered on the DSS-8125 for Medicare B, EIS does not enter an end date, or
        b. If the most current data on the MMA monthly response file is “N” for Medicare B Entitlement and the Medicare indicator in EIS is “Y”, the end date is the Entitlement End Date from the MMA response file. A new segment with “N” will have a start date that will be the end date from the response file plus 1 day.
      5. Posted Date

        This is the date the changes from the MMA monthly response file process in EIS, the DSS-8125 processes in EIS, or a correction keyed by Claims Analysis staff processes in EIS.

      6. Updated By?
        a. MMA - MMA monthly response file
        b. EIS - County
        c. DMA - Claims Analysis Unit

REVISED 10/01/08 – CHANGE NO. 01-09

Top Of Page

VII. INDIVIDUAL MEDICARE C (MC)

    A. Medicare C Data

      Medicare C data is populated by the MMA monthly response file.

      1. RSDI Claim Number
      2. Contract Number
      3. Start Date
      4. End Date
      5. Posted Date

        This is the date the changes from the MMA monthly response

        file process in EIS.

      6. Updated By?

        MMA - MMA monthly response file

      7. Organization Name

        Name of the Part C organization name.

      8. Plan Name

        Name of the Part C plan benefit.

REVISED 10/01/08 – CHANGE NO. 01-09

Top Of Page

VIII. INDIVIDUAL MEDICARE D ENTITLEMENT DATA (MD)

    To view an individual’s most current Medicare D Entitlement data, enter “MD” in the SELECTION field and the ten digit Individual ID in the KEY field. Press ENTER. The following screen appears.

    Press “PF5” to go back to view Medicare AB Data (MB), or

    Press “PF6” to go back to view Medicare C Data (MC).

    Press “PF7” to page Backwards

    Press “PF8” to page Forward

    Press “PF10 to view Medicare D Enrollment Data (ME).

    The screen displays:

    A. Individual Data

      1. Recipient ID
      2. Recipient Name
      3. Social Security Number

    B. Medicare D Entitlement Data

      1. Medicare D Status Code

        This code indicates whether Medicaid or Medicare will pay for prescription drugs. The Medicaid Drug Coverage indicator is based on the Medicare D Entitlement code.

REISSUED 10/01/08 – CHANGE NO. 01-09

VIII. B. 1 (CONT'D)

        a. Y - Yes, populated by MMA monthly response file
        b. N - No, populated by MMA monthly response file and by the county using information entered into the DSS-8125 screen at application approval
        c. Z - Yes, populated by the county entering “Y” for either Medicare A and/or B on the DSS-8125.
      2. RSDI Claim Number
        a. Populated by claim number keyed on the DSS-8125 by the county, or
        b. Populated from the MMA monthly response file.
      3. Start Date
        a. If a “Y” is entered on the DSS-8125 for Medicare A and/or B and the code on the Medicare screen for Medicare D is “Z”, EIS does not enter a start date, or
        b. If an “N” is entered on the DSS-8125 for Medicare A and/or B and the most current segment is a “Z”, EIS builds an “N” segment with a start date of the 1st day of the next month (using current day and not cycle month), or
        c. EIS uses the start date of Medicare Entitlement from the MMA monthly response file.
      4. End Date
        a. If an “N” is entered on the DSS-8125 for Medicare A and/or B, EIS does not enter an end date, or
        b. If the most current data on the MMA monthly response file is “N” for Medicare A Entitlement and the Medicare indicator in EIS is “Y”, the end date is the Entitlement End Date from the MMA response file. A new segment with “N” will have a start date that will be the end date from the response file plus 1 day.

REVISED 10/01/08 – CHANGE NO. 01-09

VIII. B (CONT'D)

      5. Medicaid Drug Coverage Indicator

        This field is updated by EIS to indicate whether Medicaid is paying for prescription drugs for the Medicare recipient. EIS creates the indicator based on the Medicare D Entitlement indicator.

        a. If the Medicare D Entitlement indicator is “Z” or “Y”, Medicaid will not pay for prescription drugs.
        b. If the Medicare D Entitlement indicator is “N”, Medicaid will pay for prescription drugs.
      6. Coverage Date

        Date that the Medicaid Drug Coverage indicator is effective. This will be the ongoing month for changes.

        a. For approvals, the Medicaid Drug Coverage date will be the Retro 1 Effective Date on the DSS-8125. If Retro 1 not entered, the Medicaid Drug Coverge date will be the earlier of the Certification From Date or the Medicaid Effective Date.
        b. A new Medicaid Drug Coverage segment with a new effective date is created when there is a change in the Medicare D Entitlement indicator.
        c. The Medicaid Drug Coverage indicator date cannot be prior to January 2006.
      7. Posted Date

        This is the date the changes from the MMA monthly response file process in EIS, the DSS-8125 processes in EIS, or a correction keyed by Claims Analysis staff processes in EIS.

      8. Updated By?
        a. MMA - MMA monthly response file
        b. EIS - County
        c. DMA - Claims Analysis Unit
      9. Timely Notice

        This is the date that a timely notice was mailed out advising the recipient that they no longer have Medicaid drug coverage.

REVISED 10/01/08 – CHANGE NO. 01-09

VIII. B (CONT'D)

      10. Adequate Notice

        This is the date that an adequate notice was mailed out advising the recipient that Medicaid drug coverage has been reinstated.

      11. Organization Name

        Name of the Part D organization name.

      12. Plan Name

        Name of the Part D plan benefit.

Top Of Page

IX. INDIVIDUAL MEDICARE D Enrollment DATA (ME)

    To view an individual’s most current Medicare D enrollment data, enter “ME” in the SELECTION field and the ten digit Individual ID in the KEY field. Press ENTER. The following screen appears.

    Press “PF4” to go back to view Medicare Entitlement Data (MD), or

    Press “PF5” to go back to view Medicare A/B Data (MB).

    Press “PF6” to go back to view Medicare C Data (MC).

    Press “PF7” to page backward.

    Press “PF8” to page forward.

    A. Medicare D Enrollment

      1. Start Date

        EIS uses the start date of Medicare D enrollment from the MMA monthly response file.

REVISED 10/01/08 – CHANGE NO. 01-09

IX. A. (CONT'D)

      2. End Date

        EIS uses the End Date of Medicare D enrollment from the MMA monthly response file.

        Note: If Medicare A and B on the response file both have end dates, EIS will use the later of the two dates.

      3. Type

        This field identifies how the recipient was enrolled by CMS in a PDP.

        a. Auto - Automatically enrolled in PDP
        b. Beneficiary Choice - PDP chosen by the beneficiary
        c. Affirmatively Declined - Beneficiary declined auto- enrollment in PDP and did not enroll on his/her own
        d. Facilitated – Automatic enrollment of MQB recipients in PDP
      4. Contract Number

        Number which identifies a contract offered within a PDP.

      5. Plan Number

        Number which identifies the PDP that the recipient is enrolled in.

      6. Posted Date

        This is the date the changes from the MMA monthly response file process in EIS.

      7. Updated by?

        MMA - MMA monthly response file

      8. Organization Name

        Name of the Part D organization.

      9. Plan Name

        Name of the Part D plan benefit.

REVISED 10/01/08 – CHANGE NO. 01-09

Top Of Page

X. PACE/MANAGED CARE HISTORY INQUIRY (MI)

    To view an HMO, PACE, or Carolina Alternatives managed care segment, key “MI” in the SELECTION field on any IMS screen, the individual ID in the KEY field, and press ENTER. The PACE/MANAGED CARE HISTORY INQUIRY SCREEN is displayed:

Top Of Page

XI. ASSETS TRANSFER INQUIRY/UPDATE (AT)

    To view the Assets Transfer Tracking Screen, key “AT” in the SELECTION field on any IMS screen, the individual ID in the KEY field, and press ENTER.

    The following screen appears:

Previous PageTop Of PageNext Page



 


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