NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL
ELIGIBILITY INFORMATION SYSTEM EIS 3101
CHANGES TO MEDICAID CASES
I. COMPLETING THE DSS-8125
II. SIGNATURES AND DATE
III. KEY THE DSS-8125.
V. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.
VI. AUTOMATED NOTICES
CHANGE IN MEDICAID CLASSIFICATION
REVISED 08/01/98 - CHANGE NO. 03-99
The Medicaid classification of a MQB case can not be changed to “E” if the funding for this classification is exhausted for the calendar year. The case must be terminated, changed to another aid program/category, or changed to another Medicaid classification.
When funding is exhausted, EIS stops accepting additional MQB-E cases, therefore pending timely forms that are waiting to process that are changes in Medicaid classification to “E” are put on hold. The following message appears on the Error and Attention Report for the forms put on hold: “FORMS ON HOLD - FUNDING FOR MQB-E EXHAUSTED”. Also, the following online message is displayed: “MQB-QI FUNDS EXHAUSTED. CAN ONLY DELETE/RESCIND FORM”, if you redisplay the form in Function 8 and press <enter>. You must either delete or rescind the forms that are put on hold. Since the case can not be changed to MQB with a Medicaid classification of “E”, determine eligibility for another Medicaid classification or another aid program/category.
NOTE: FOR CAP CASES, DO NOT ENTER CHANGE CODE. COMPLETE A MANUAL NOTICE.
If you are changing the Medicaid Class to “B”, “C”, “N”, or “M” from “B”, “C”, “N”, or “M”, a change code is not required.
It is important to enter the correct code. See the Codes Appendix to determine the appropriate code. Unless overridden, an automated notice is produced based on the change code entered on the DSS-8125.
REISSUED 08/01/98 - CHANGE NO. 03-99
I. A. 8. b. (CONT'D) (CHANGE IN MEDICAID CLASSIFICATION)
The change code not only determines the text of the notice but also whether the notice is adequate or timely. See AUTOMATED NOTICES at the end of this section for more information regarding the automated notice.
NOTE: FOR CAP CASES, DO NOT ENTER NOTICE OVERRIDE OF “Y”. COMPLETE A MANUAL NOTICE.
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 the DSS-8125 when submitting to Data Entry for keying.
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.
Do not use for changes.
This section may be used if no code exists for your situation and/or to provide additional information to the recipient. If this text is used, you must enter change code “02” or “50”. If you use Notice Text, you must enter a manual citation.
REVISED 10/01/12 - CHANGE NO. 01-13
I. B. (CONT'D) (CHANGE IN MEDICAID CLASSIFICATION)
8. Disability Indicator (DIS)
NOTE: ALL OTHER FIELDS ARE OPTIONAL. A DETAILED EXPLANATION OF EACH FIELD IS INCLUDED IN ”OTHER CHANGED DATA”.
When the DSS-8125 processes successfully, the following are received:
All changes completed by an IMC are reported on the Caseworker Supervisor Report. The number of actions completed is determined from the WORKER NUMBER.
REISSUED 10/01/012 - CHANGE NO. 01-13
(CHANGE IN MEDICAID CLASSIFICATION CONT’D)
REVISED 10/01/09 - CHANGE NO. 01-10
VI. C. 4. (CONT'D) (CHANGE IN MEDICAID CLASSIFICATION)
For example: A DSS-8125 indicating a change with an effective date of July 1, 1996 and a timely reason code for an automated notice is keyed June 12, 1996. The eleventh workday is June 28, 1996. The keying deadline is June 25, 1996. EIS changes the Medicaid Effective Date to August 1, 1996.
This action is reported on the Notice Register for that day. The information related to the automated notice is displayed with an asterisk (*) entered in the “CHANGE/TERMINATION DATE” column of the report.
Because the action does not actually process in EIS until the eleventh county workday, it is possible to stop the action. To do so, you must have your Data Entry Operator delete the action that is on hold in EIS. The deletion must occur no later than the eleventh county workday from the date of the notice.
Delete the pending action using one of the following methods.
NOTE: FORM ID NUMBERS ARE LISTED ON THE NOTICE REGISTERS AND ARE AVAILABLE THROUGH INQUIRY IN XPTR FOR THREE DAYS AFTER THE DSS-8125 IS KEYED.
This action is reported on the Notice Register for that day. The information related to the automated notice is displayed with “DELETED” noted in the “COMMENTS” column of the register.
REISSUED 10/01/09 - CHANGE NO. 01-10
VI. C. (CONT'D) (CHANGE IN MEDICAID CLASSIFICATION)
There is another situation where an action pending in EIS is stopped.
If a subsequent DSS-8125 is keyed by the eleventh county workday from the date of the notice and the subsequent DSS-8125 causes a new notice to be produced, the pending action is stopped. In this situation, EIS “rescinds” the pending action and produces an automated notice for the new action.
Both actions are reported on the Notice Register for that day. The information related to the first automated notice is displayed with “RESCINDED” noted in the “COMMENTS” column of the register. The information related to the subsequent automated notice is also displayed with no entry in the “COMMENTS” column.