NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2268

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DMA-5022 INSTRUCTIONS FOR SPECIAL ASSISTANCE APPLICATION APPROVALS

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EIS 2268 - DMA-5022 INSTRUCTIONS SPECIAL ASSISTANCE application approvals


I. USE THE DMA-5022 WHEN APPROVING AN APPLICATION TO:

II. COMPLETE SECTION A OF THE DMA-5022 TO REQUEST ANY BENEFIT LISTED IN II. ABOVE. FOLLOW THE INSTRUCTIONS BELOW.

III. DO NOT COMPLETE SECTION B OF THE DMA-5022 TO AUTHORIZE RETROACTIVE MEDICAID BENEFITS YOU CANNOT AUTHORIZE USING THE DSS-8125. You must use the DB/PML function. See EIS 3105.

IV. COMPLETE SECTION C OF THE DMA-5022 TO REQUEST MONEY PAYMENT BENEFITS. FOLLOW THE INSTRUCTIONS BELOW TO REQUEST THE APPROPRIATE BENEFITS.

V. COMPLETE THE SIGNATURES AND DATES SECTION.

VI. USE OF A SECOND DMA-5022

VII. SUBMIT THE DMA-5022 TO DATA ENTRY FOR KEYING.

VIII. OUTPUTS


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EIS 2268 - DMA-5022 INSTRUCTIONS SPECIAL ASSISTANCE application approvals

REISSUED 01/01/05 - CHANGE NO. 04-05

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I. USE THE DMA-5022 WHEN APPROVING AN APPLICATION TO:

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II. COMPLETE SECTION A OF THE DMA-5022 TO REQUEST ANY BENEFIT LISTED IN II. ABOVE. FOLLOW THE INSTRUCTIONS BELOW.

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III. DO NOT COMPLETE SECTION B OF THE DMA-5022 TO AUTHORIZE RETROACTIVE MEDICAID BENEFITS YOU CANNOT AUTHORIZE USING THE DSS-8125. You must use the DB/PML function. See EIS 3105.

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IV. COMPLETE SECTION C OF THE DMA-5022 TO REQUEST MONEY PAYMENT BENEFITS. FOLLOW THE INSTRUCTIONS BELOW TO REQUEST THE APPROPRIATE BENEFITS.

REVISED 01/01/05 - CHANGE NO. 04-05

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V. COMPLETE THE SIGNATURES AND DATES SECTION.

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VI. USE OF A SECOND DMA-5022

REISSUED 11/01/01 - CHANGE NO. 06-02

VI. CONTINUED

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VII. SUBMIT THE DMA-5022 TO DATA ENTRY FOR KEYING.

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VIII. OUTPUTS

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