NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2251

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EIS 2251 - APPROVING M-AA, M-AB, AND M-AD NEW APPLICATIONS OR REAPPLICATIONS


I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUT

V. AUTOMATED NOTICES


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EIS 2251 - APPROVING M-AA, M-AB, AND M-AD NEW APPLICATIONS OR REAPPLICATIONS

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

Top Of Page

I. GENERAL INFORMATION

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

I. E. (CONT’D)

      2. Enter “N” or “M” Medicaid Classification code on the DSS-8125 approval and a Medicaid Effective Date as the first month of eligibility for that classification. If this option is chosen, after the approval processes overnight, key a DSS-8125 to change the Medicaid Classification to “Q” with a Medicaid Effective Date as the month after the month of disposition of the application.

F. 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 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.

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

      1. Authorization is for multiple certification periods which cannot be entered on the DSS-8125.
2. Changing the living arrangement code 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.
      3. 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.

    H. 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.

    I. Each piece of a two part Medicaid application may be dispositioned (approved/denied/withdrawn) regardless of whether the other part is being dispositioned at the same time.

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

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

I. (CONT’D)

    K. When an individual reapplies for both MAABD and SAA/SAD against the same closed case ID and the SAA/SAD application is approved first, the MAABD application must be administratively denied. If the applicant is eligible for MAABD prior to the SAA/SAD eligibility, complete an administrative DSS-8124 application as “NEW” under MAABD 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 SAA/SAD case will be closed.

    L. 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.

    M. If the MQB application has been approved for ongoing and you are ready to approve MAABD ongoing, the MQB must be terminated. The next day the MAABD can be approved for ongoing coverage.

      NOTE: The only timing problem this procedure may cause is when the MQB case is terminated on the 5th workday of the month, and the MAABD is approved on the 6th workday of the month using a disposition date for the previous month. Remember, in this situation, the system changes the disposition date to the current day even if the notice is overridden.

    N. When the retroactive coverage of a two part Medicaid application is dispositioned after the ongoing coverage, the retroactive information does not update the current case data. The retroactive eligibility is posted in the Individual Eligibility (“IE”) segment and may be viewed through inquiry.

    O. 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).

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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.

REISSUED 2/01/11 - CHANGE NO. 03-11

II. A. (CONT'D)

      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 AID PROGRAM/CATEGORY. If a change is needed, it must be reentered on the Application Turnaround before approval is keyed.
      11. Do not enter CASEHEAD/PAYEE NAME. Refer to EIS 3101 for making changes to the CASEHEAD/PAYEE.
      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.

        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 CITY, STATE, and ZIP CODE if different than indicated on the Application Turnaround. See the 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

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

II. A. (CONT'D)

      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. Enter the number in the NEEDS UNIT if MQB Family Size Budgeting was used.
      19. Do not enter CHANGE CODE.
      20. Enter “Y” in NOTICE OVERRIDE if you wish to override the automated notice.

        Always override the automated notice when:

        a. You use the DB/PML transaction to issue any benefits. This includes approving a dual application when you must use DB/PML transaction for months before “Q” eligibility.
        b. You cannot enter all Patient Monthly Liabilities on the DSS-8125.
        c. You have an individual in long-term care with a deductible.

    B. APPLICATION DATA

      1. Enter the APPLICATION NUMBER from the Application Turnaround.
      2. If you are 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 you 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 NOTICES at the end of this section for more information regarding the automated notice.

        NOTE: IF THE NOTICE IS OVERRIDDEN, THE DISPOSITION DATE MUST BE THE SAME DATE THE APPROVAL NOTICE IS MAILED TO THE RECIPIENT.

    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 CERT THRU month. See the Codes Appendix to determine the appropriate termination reason code.

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

II.C. (CONT'D)

      2. If approving Emergency Services only for an alien, you must enter CASE TERMINATION REASON and DATE. The DATE must be the last day of the CERT THRU month.
      3. 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 prior to the month of application.
      4. Enter the OLD CASE TERMINATION REASON and DATE if you are approving a reapplication and the case you are reapplying against is still open. The date must be the last day of the month before the ongoing month.

      See the Codes Appendix to determine the appropriate termination reason code.

    D. DO NOT ENTER PAYMENT DATA.

    E. MEDICAID DATA

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

      1. Enter MEDICAID STATUS “A” for authorized.

        If the case being approved has CAP coverage:

        a. Enter “A” for authorized and Y in the Notice Override field and send a manual notice, or

          enter APPROVAL CODE “A1” and use the Supplemental Notice Text.

        b. Enter “D” for deductible and Y in the Notice Override field and complete a manual notice.
      2. Enter MEDICAID EFFECTIVE DATE.

        NOTE: THIS DATE MAY BE ANY DAY OF THE MONTH. MUST NOT BE PRIOR TO 1-1-93 FOR MEDICAID CLASS “B”.

        a. If approving ongoing coverage:
          (1) This date must not be before the application month.
          (2) This date must fall within the certification period.

REVISED 02/01/11 – CHANGE NO. 03-11

II.E. 2. a. (CONT'D)

          (3) 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 the DB/PML function.

          (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 classification is “Q”, the MEDICAID EFFECTIVE DATE must be the month following the month of disposition. There are two options for approving a dually eligible case. See I.E. above for the options.

            To authorize benefits for the month of application through the disposition month, a DB/PML transaction is required with class of “C”, “N”, or “M”.

            Refer to EIS 3105, DB/PML Transaction Instructions for Medicaid Application Approvals for completing the DB/PML function.

        b. 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.
          (2) This date must be before or the same as the ongoing processing month.
          (3) This date must be before or the same as the CASE TERMINATION DATE if the case is approved in terminated status (Open/Shut).
          (4) This date must be before or the same as the CASE TERMINATION DATE if the case is approved in terminated status (Open/Shut).
      3. CERTIFICATION FROM DATE
        a. For ongoing coverage, enter the CERTIFICATION FROM DATE. This date must be the first day of the month and

REISSUED 02/01/11 – CHANGE NO. 03-11

II. E. 3. a.(CONT'D)

          (1) It may be the first day of the application month, or
          (2) For applications that have pended for six months or more, it may be the application month plus six.
        b. For retroactive coverage with ongoing, enter the CERTIFICATION FROM DATE. This date must be the first day of the application month unless the application has been pending beyond the first certification period. Then, the CERTIFICATION FROM DATE must be application month plus six.

          NOTE: IF THE CERTIFICATION FROM DATE IS EQUAL TO THE APPLICATION MONTH PLUS SIX, COMPLETE A DB/PML TRANSACTION TO AUTHORIZE MEDICAID FOR THE FIRST CERTIFICATION PERIOD.

      4. Enter the CERTIFICATION THRU DATE.
        a. The date may be up to twelve months from the CERTIFICATION FROM DATE.
        b. For a CAP case, the date must be six months from the CERTIFICATION FROM date.
        c. The date must be after or the same as the MEDICAID EFFECTIVE DATE.
        d. If CASE TERMINATION DATE is present, the CERTIFICATION THRU DATE must be the month and year of termination.
        e. 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. Otherwise, it must be the last day of the month.
      5. Enter MEDICAID CLASS.
      6. Enter “D” for deductible balance or “P” in the DEDUCTIBLE/PATIENT MONTHLY LIABILITY (DB/PML) field, if applicable.
        a. If the MEDICAID EFFECTIVE DATE is any day other than the first day of the month, an entry in the DB/PML field is required, unless this is an alien case, then this field is optional.
        b. If LIVING ARRANGEMENT is long-term care, then “P” is required.

REISSUED 02/01/11 – CHANGE NO. 03-11

II. E. (CONT'D)

      7. Enter the DB/PML AMOUNT if DB/PML type is entered. The AMOUNT may be all zeroes.

    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 04/96 and 06/96, 04/96 must be entered in RETRO MA 1.

      1. RETRO MA 1
        a. Enter the AID PROGRAM/CATEGORY under which the retroactive coverage is given.
          (1) If you are approving a M-AA case, the retroactive coverage may be given under M-AA, or MQB(B). MAD should be given on a separate application since a date screen is required for MAD but not allowed for MAA.
          (2) If you are approving a M-AD case, retroactive coverage may be given ONLY under M-AD. MQB(B) should be on a separate application since a date screen is required for MAD but not allowed for MQB(B).
          (3) If you approving a M-AB case, retroactive coverage may be given under M-AB or MQB(B).
        b. Enter AUTHORIZATION FROM and AUTHORIZATION THRU dates.
          (1) The AUTH FROM DATE may be up to three months before the month of application and may be any day of the month.
          (2) The AUTH FROM DATE must not be prior to 1/1/93 for Medicaid class “B”.
          (3) The AUTH THRU DATE must be the last day of the month unless RETRO MA1 MED CLASS is “F” or “0”; in this case, the date can be any day of the month.

REISSUED 02/01/11 – CHANGE NO. 03-11

II. F. 1. (CONT'D)

        c. Enter MEDICAID CLASS for the retroactive period. Must enter “B” for MQB.
        d. Enter DB/PML if applicable for the retroactive period. This is required if the RETRO MA 1 AUTH FROM date is not the first day of the month.
        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 has been completed. If there is a break in the retroactive coverage, complete RETRO MA 2. RETRO MA 2 must be the most recent retroactive period.

        a. Enter the AID PROGRAM/CATEGORY under which the retroactive coverage is given.
          (1) If you are approving an M-AA case, retroactive coverage may be given under M-AA or MQB. MAD should be on a separate application since a date screen is required for MAD but not allowed for MAA.
          (2) If you are approving an M-AD case, retroactive coverage may be ONLY given under M-AD. MQB(B) should be on a separate application since a date screen is required for MAD but not allowed for MQB(B).
          (3) If you are approving an M-AB case, retroactive coverage may be given under M-AB or MQB.
        b. Enter AUTHORIZATION FROM AND AUTHORIZATION THRU DATES.

          The RETRO MA 2 AUTH FROM and AUTH THRU DATES MUST be after RETRO MA 1 AUTH THRU DATE.

          (1) The AUTH FROM DATE may be any day of the month.
          (2) The AUTH FROM DATE must not be prior to 1-1-93 for Medicaid class “B”.
          (3) The AUTH THRU DATE must be the last day of the month unless RETRO MA 2 MED CLASS is “F” or “0”, in this case, the date can be any day of the month.

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

II.F.2. (CONT'D)

        c. Enter MEDICAID CLASS for the retroactive period. Must enter “B” for MQB.
        d. Enter the DB/PML if applicable for the retroactive period. This is required if RETRO MA 2 AUTH FROM DATE is not the first day of the month.
        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.)

    G. EARNED INCOME (IF ZERO, LEAVE BLANK)

      All fields must be in dollars and cents.

      1. Enter the amount of GROSS EARNED INCOME.
      2. Enter the amount of WORK EXPENSES.
      3. Enter CHILD/ADULT CARE if applicable.
      4. Enter the amount of DISREGARD.
      5. Enter the amount of 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 dollars and cents.

      1. Enter the SSI amount for long-term care cases only.
      2. Enter the RSDI AMOUNT. If entered, RSDI CLAIM NUMBER is required.
      3. Enter the TOTAL NET UNEARNED INCOME. For long-term care cases with an SSI amount entered, the TOTAL NET UNEARNED INCOME must be the same as or more than the SSI amount.
    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.

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

II. (CONT'D)

      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.

    K. NEEDS

      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. If entered, TOTAL NET UNEARNED INCOME or NET EARNED INCOME must be entered.

    L. SPECIAL DATA

      1. Do not enter FOOD STAMP NUMBER.
      2. Do not mark STEPPARENT INDICATOR.
      3. Enter GRANDFATHER STATUS CODE and DATE if applicable. This is allowed on reapplications only.
      4. Mark “YES” or “NO” for VA PAYMENT.
      5. Enter SPECIAL REVIEW TYPE and DATE if applicable. This is not allowed if the approval is Open/Shut.
      6. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.
      7. Enter SPECIAL USE CODE and DATE if applicable. This is not allowed for Open/Shut approvals.

    M. SPECIAL COVERAGE GROUPS INCLUDING SPECIAL NEEDS

      1. Enter SPECIAL COVERAGE CODE, BEGIN DATE or END DATE if case is a CAP case.

        NOTE: DO NOT ENTER END DATE IF CAP COVERAGE HAS NOT ENDED.

      2. Do not enter SPECIAL NEEDS INDIVIDUAL ID, SPECIAL NEEDS CODE, SPECIAL NEEDS FROM DATE, or SPECIAL NEEDS THRU DATE.

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

II. (CONT'D)

    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 Fields

        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.

        If an applicant is a CAP recipient, the CAP Case Manager’s name and address must be entered for the purpose of mailing an automated notice to the CAP Case Manager 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. This includes information about CAP services for an automated notice.

        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 data for all the individuals that are included on the case will be brought forward from the case or 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 function to make the appropriate correction(s).

      Enter the following data:

      1. Do not enter INDIVIDUAL TERMINATION DATE.

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

II. O. (CONT'D)

      2. Enter CASE STATUS of “R”.
      3. Enter the RSDI CLAIM NUMBER if the individual has Social Security benefits or Medicare coverage.
        a. A “Z” suffix is not allowed if:
          (1) The Medicaid Classification is Q or B.
          (2) The individual is under 65 years of age in the ongoing month.
        b. The RSDI CLAIM NUMBER:
          (1) Can not be blank or zeroes if the Medicaid Classification code is Q or B.
          (2) Must be the individual’s own Social Security number if the RSDI CLAIM NUMBER suffix is A, M, or T.
          (3) Is the individual’s Social Security Number with a suffix of “Z” for an alien who does not qualify for Medicare due to not having five years of residency in the U.S. and who is age 65 or over in the ongoing month. This will allow claims for the alien to bypass Medicare editing.
      4. Enter “Y” or “N” in MEDICARE A to indicate whether or not the individual has Medicare A. If yes, you must enter an RSDI claim number.
      5. Enter “Y” or “N” in MEDICARE B to indicate whether or not the individual has Medicare B. If yes, you must enter an RSDI claim number.
      6. Enter FAMILY STATUS for M-AB and M-AD. (EIS generates for M-AA.)
        a. If the individual is 19 years old or older FAMILY STATUS must be “A”.
        b. If the individual is less than 19 years old, FAMILY STATUS must be “C”.
      7. Enter LIVING ARRANGEMENT CODE. If case is long-term care, DB/PML field must be “P”. See the Codes Appendix for the appropriate living arrangement code.
      8. Enter SPECIAL REPORT code if applicable. See the Codes Appendix for the appropriate Special Report code.
      9. Do not enter JOBS/WORK REGISTRATION/EXEMPTION.

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

II. O. (CONT'D)

      10. Enter SPECIAL USE DATA CODE and DATA(s) if applicable. See the Codes Appendix to determine the appropriate Special Use Codes and Data.
      11. Enter the REFUGEE STATUS CODE and U.S. ENTRY DATE (in MMCCYY format), if applicable. 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. CASE TERMINATION REASON must be code 52.
        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. The DATE OF DEATH must not be more than three months prior to the month of application.
      13. Enter the two digit CITIZEN/ID code and the date (in MMDDCCYY format), if applicable. Enter Citizen/ID codes for refugee, 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.
      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.

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

II. O. (CONT'D)

      22. Do not enter EDUCATIONAL LEVEL.
23. Enter type and date of EDUCATION provided. 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. 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.

    P. SIGNATURES AND DATE

      1. Enter DATE COMPLETED by the worker.
      2. Write WORKER'S SIGNATURE.
      3. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

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III. KEY THE DSS-8125.

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IV. OUTPUT

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

    A. DMA-5016 (PATIENT LIABILITY INFORMATION)

      The DMA-5016(s) for the current and/or retro periods, is produced the night the approval processes and is mailed the following workday to the appropriate facility indicated by the address or facility code(s) entered.

    B. CASE PROFILE

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

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

IV. (CONT'D)

    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. CASEWORKER SUPERVISOR REPORT

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

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V. AUTOMATED NOTICES

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

    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.

    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 the CAP Case Manager if the “Authorized Rep” name and address fields are entered on the DSS-8125. A copy of the notice is not mailed to the county.

    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.

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