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NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3000

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BENEFIT ISSUANCE FOR ACTIVE CASES

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EIS 3000 - BENEFIT ISSUANCE FOR ACTIVE CASES


I. GENERAL INFORMATION

II. Medicaid Benefit Issuance

III. Medicaid Card Reports


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EIS 3000 - BENEFIT ISSUANCE FOR ACTIVE CASES

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

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I. GENERAL INFORMATION

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II. Medicaid Benefit Issuance

    A. Medicaid Identification Card

    The Division of Medical Assistance issues a Medicaid identification card to each eligible recipient at initial application approval; when a replacement card is requested; and on the one year anniversary of the last card issuance date. Additionally, certain individual and case changes automatically generate the issuance of a replacement card.

    The Medicaid ID card is not proof of Medicaid eligibility for any Medicaid covered service. Providers are responsible for verifying the current eligibility status of the individual presenting the card at each visit.

    B. New Approvals

    County caseworkers can issue a Medicaid ID card at application approval if the recipient does not have an annual card from a prior eligible period. The new card is generated the night the approval processes and is mailed to the recipient the following work day. The card issuance date is displayed on the recipient’s Individual Inquiry (ID) screen.

    C. Replacement Cards

    Replacement Medicaid ID cards can be requested by the county at any time by using the DB/PML (“P”) screen. The card is generated in the over night batch process and mailed to the recipient the following work day. Replacement cards are printed on the same gray card stock as the annual issue card. Replacement card issuance updates the last card issue date on the recipient’s Individual Inquiry (ID) screen.

    D. Annual Card Issuance

    EIS issues a new Medicaid ID card for each eligible recipient whose last annual card or replacement card was issued 12 months ago. The recipient’s Individual Inquiry (ID) screen is updated with the annual card issuance date.

    E. Changes that Automatically Issue Medicaid ID Cards

    The following case and/or individual changes will cause EIS to automatically issue a Medicaid ID card.

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

II. E. (CONT’D)

      1. When the recipient first, middle and/or last name changes in the Common Name Data Service (CNDS), EIS automatically issues a new card the night the name change processes. The card is mailed the following work day.
      2. EIS automatically issues a new card when the Primary Care Physician (PCP) changes from one provider to another; when it changes from exempt to a PCP; and when it changes from PCP to exempt. Individual PCP changes are accumulated throughout the month. On the program cut-off or keying deadline (fourth work night from the end of the month), the most current PCP record for the individual is used to create the card. The card is mailed the following work day.
      3. EIS automatically issues a card when a recipient transfers from NCHC to Medicaid. The card is generated the fourth work night from the end of the month, and is mailed the following work day.
      4. EIS automatically issues a card when a recipient transfers from PACE to non-PACE. The card is generated the fourth work night from the end of the month, and is mailed the following work day.
      5. EIS automatically issues a card when a recipient goes from deductible status to authorized (for 6 month deductible cases). The card is generated the fourth work night from the end of the month, and is mailed the following work day. For 1 month CAP deductible cases, a card is issued the night the case is authorized on the P screen provided the caseworker keys ‘Y’ for issue card and no card has been issued in the last year.
      6. EIS automatically issues a card when a recipient goes from incarcerated to private living. The card is generated the fourth work night from the end of the month and is mailed the following work day.

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III. Medicaid Card Reports

    Three reports in NCXPTR list individuals issued a Medicaid identification card. These are the annual, daily and monthly Medicaid card reports. The reports are sorted by county, and display the casehead name, and the recipient name and Individual ID number.

    A. Annual Card Report (DHRWDB MED CARD ANNUAL)

      Individuals issued a card at the initial mass issuance of annual cards, and at the one year anniversary of thier last card issue date are displayed on this report.

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

III. (CONT’D)

    B. Daily Card Report (DHRWDB MED CARD DAILY)

      This report displays individuals for whom a card was generated during the nightly processing of forms keyed each day. This includes application approvals, replacement card requests, and cards generated as a result of a name change, and one month CAP cases authorized on the P screen.

    C. Monthly Card Report (DHRWDB MED CARD MONTHLY)

      This report displays individuals that had a change processed during the end of month processing.

      This includes PCP changes, transfers from NCHC or PACE to regular Medicaid, incarcerated to private living, and going from deductible to authorized status (6 month deductible cases).

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