NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3101

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CHANGES TO MEDICAID CASES

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EIS 3101 – CHANGES TO MEDICAID CASES


I. GENERAL INFORMATION

II. UPDATING THE NAME OF THE CASEHEAD/PAYEE

III. CHANGE OF PAYEE

IV. PAYEE DESIGNATION FOR MAF/MIC CASES THAT EXISTED PRIOR TO 7/1/96

V. COMPLETING THE DSS-8125

VI. SIGNATURES AND DATE-IF USING A PAPER FORM

VII. KEY THE DSS-8125.

VIII. OUTPUTS

IX. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.


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PAYEE NAME CHANGES AND CHANGES OF PAYEE

REISSUED 10/01/07 - CHANGE NO. 02-08

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I. GENERAL INFORMATION

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II. UPDATING THE NAME OF THE CASEHEAD/PAYEE

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III. CHANGE OF PAYEE

REVISED 10/01/07 - CHANGE NO. 02-08

III. A. (CONT’D) CHANGING FROM ONE CASEHEAD/PAYEE ONLY TO A DIFFERENT CASEHEAD/PAYEE ONLY:

REVISED 10/01/07 - CHANGE NO. 02-08

III.(CONT’D) (PAYEE NAME CHANGES AND CHANGES OF PAYEE)

REVISED 10/01/07 - CHANGE NO. 02-08

III. D. (CONT’D) CHANGING FROM ONE CASEHEAD/PAYEE WHO IS INCLUDED TO A DIFFERENT CASEHEAD/PAYEE WHO IS INCLUDED:

REVISED 10/01/07 - CHANGE NO. 02-08

III.(CONT’D) (PAYEE NAME CHANGES AND CHANGES OF PAYEE)

REISSUED 10/01/07 - CHANGE NO. 02-08

(PAYEE NAME CHANGES AND CHANGES OF PAYEE)

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IV. PAYEE DESIGNATION FOR MAF/MIC CASES THAT EXISTED PRIOR TO 7/1/96

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V. COMPLETING THE DSS-8125

REVISED 10/01/12 - CHANGE NO. 01-13

V. A. (CONT’D) COMPLETING THE DSS-8125

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VI. SIGNATURES AND DATE-IF USING A PAPER FORM

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VII. KEY THE DSS-8125.

REISSUE 10/01/12 - CHANGE NO. 01-13

VIII. (CONT’D) OUTPUTS

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VIII. OUTPUTS

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IX. FOR ANY CHANGES NOT LISTED, SEE ”OTHER CHANGED DATA”.

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