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. USE THE DSS-8125 TO COMPLETE ANY CHANGES TO AN ACTIVE MEDICAID CASE. THE FIELDS LISTED BELOW ARE REQUIRED ENTRIES FOR ANY CHANGE. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

II. THE FOLLOWING FIELDS MAY BE CHANGED OR UPDATED AS NEEDED UNLESS OTHERWISE INDICATED. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

III. SIGNATURES AND DATE

IV. KEY THE DSS-8125.

V. OUTPUTS

VI. AUTOMATED NOTICES


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OTHER CHANGED DATA

REISSUED 01/01/06 - CHANGE NO. 03-06

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I. USE THE DSS-8125 TO COMPLETE ANY CHANGES TO AN ACTIVE MEDICAID CASE. THE FIELDS LISTED BELOW ARE REQUIRED ENTRIES FOR ANY CHANGE. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

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II. THE FOLLOWING FIELDS MAY BE CHANGED OR UPDATED AS NEEDED UNLESS OTHERWISE INDICATED. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

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

II. A. (CONT'D) (OTHER CHANGED DATA)

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

II. A. (CONT'D) (OTHER CHANGED DATA)

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

II. C. 3. (CONT'D) (OTHER CHANGED DATA)

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

II. (CONT'D) (OTHER CHANGED DATA)

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

II. G. (CONT'D) (OTHER CHANGED DATA)

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

II. (CONT'D) (OTHER CHANGED DATA)

REISSUED 05/01/09 - CHANGE NO. 03-09

II.N. (CONT'D) (OTHER CHANGED DATA)

REISSUED 05/01/09 - CHANGE NO. 03-09

II.N. (CONT'D) (OTHER CHANGED DATA)

REISSUED 05/01/09 - CHANGE NO. 03-09

II.N. (CONT'D) (OTHER CHANGED DATA)

      32. CHILD/ADULT CARE: Do not enter.
      33. NET EARNED INCOME: Do not enter.
      34. EDUCATIONAL LEVEL: Do not enter.
      35. EPICS CLAIM INDICATOR: Do not enter.

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III. SIGNATURES AND DATE

      1. Enter the DATE COMPLETED.
      2. WORKER'S SIGNATURE: Write your name is this field.
      3. DIRECTOR'S SIGNATURE: The county director or his designee must sign the form in this field.

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IV. KEY THE DSS-8125.

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V. OUTPUTS

    A. Case Profile

      An updated Case Profile is produced the night the change processes and is mailed to the county the following workday.

    B. Caseworker Supervisor Report

      All changes completed by an IMC are reported on the Caseworker Supervisor Report. The number of actions completed is determined from the WORKER NUMBER.

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VI. AUTOMATED NOTICES

    A. General Information

      1. An automated notice (DSS-8110A) is produced for all changes the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE”. A sample of the DSS-8110A is located at the end of this section.
      2. The CHANGE CODE entered on the DSS-8125 determines the text of the notice and whether the notice is adequate or timely.
      3. The system calculates the 60th calendar day for the notice.
      4. The date of the automated notice is the next county workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient. A copy of the notice is not mailed to the county.

REISSUED 05/01/09 - CHANGE NO. 03-09

VI.A (CONT'D) (OTHER CHANGED DATA)

      5. 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 3556 for more information regarding the Notice Register Report.

    B. Adequate Notice

      1. “Adequate” is indicated at the top of the notice.
      2. The system calculates the 60th calendar day for the notice.
      3. The action indicated on the DSS-8125 takes place in EIS the same night the adequate notice is produced.

    C. Timely Notice

      1. “Timely” is indicated at the top of the notice.
      2. To produce an automated timely notice, you must complete the DSS-8125 and have it keyed into EIS at the same time you would have completed the manual DSS-8110.
      3. The system calculates the tenth county workday and the 60th calendar day for the notice.
      4. The action takes place in EIS eleven county workdays from the date of the notice. If the eleventh county workday falls after pull, EIS adjusts the month of change to the next benefit month.

        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 pull 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.

      5. No further action is required by you for the action to occur.

ISSUED 05/01/09 - CHANGE NO. 03-09

      6. An updated Case Profile is produced the night the action takes place in EIS.
      7. Deleting the Action

        Because the action does not actually process in EIS until the eleventh county workday, it is possible to stop the action. To do so, 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.

        a. Submit a copy of the DSS-8125 you sent originally to request the change. Write “DELETE” in red across the top of the form; or
        b. Submit a county form developed for this purpose. This form must contain the form ID number of the original DSS-8125 and a message to Data Entry to delete the form.
        c. See EIS 4900, DATA ENTRY APPENDIX E.

        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.

      8. Rescinding the Action

        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 also is displayed with no entry in the “COMMENTS” column.

ISSUED 05/01/09 - CHANGE NO. 03-09

      9. DSS-8125 and Timely Pending Action
        a. A DSS-8125 may not be placed on hold when there is a timely action pending.
        b. A DSS-8125 may be keyed, but if a change code or termination code is present, it will rescind the pending action.
        c. Demographic data may be keyed up until the day before a timely action is to process without rescinding the pending action. Following are examples of demographic data:
          (1) County Number
          (2) County Case Number
          (3) District Number
          (4) Address
          (5) RSDI Claim Number

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