NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 4200

----------------------------------------------------------------------

SSI MEDICAID-CHANGING AN SSI MEDICAID CASE - PART FIVE

----------------------------------------------------------------------

DHHS Home Page NC DHHS On-Line Manuals
View Manual in PDF      DHHS Manual Home Manual Admin Letters Change Notices Archive Search Index Help Feedback

EIS 4200 – SSI MEDICAID-CHANGING AN SSI MEDICAID CASEPART FIVE


I. SDX CONTROLLED DATA

II. COUNTY/SDX CONTROLLED DATA

III. SDX CHANGES

IV. ALLOWABLE COUNTY CHANGES

V. INSTRUCTIONS FOR ALLOWABLE CHANGES


Previous PageTable Of ContentsNext Page

EIS 4200 – SSI MEDICAID-CHANGING AN SSI MEDICAID CASE
PART FIVE

REISSUED 09/01/06 - CHANGE NO. 02-07

CHANGING AN SSI/MEDICAID CASE

The SDX controls certain data for SSI Medicaid cases in EIS. Other data can be changed in EIS by the IMC.

Top Of Page

I. SDX CONTROLLED DATA

REVISED 09/01/06 - CHANGE NO. 02-07

Top Of Page

II. COUNTY/SDX CONTROLLED DATA

 

TYPE OF SSI MEDICAID CASE

 

MAABD/PLA

MAABD/LTC

SAA/SAD

HSF

AAF TYPE 5, 6, OR 7

ADDRESS

SDX

COUNTY

COUNTY

COUNTY

COUNTY

AID PROGRAM CATEGORY

SDX

SDX

SDX

COUNTY

COUNTY

CAP

COUNTY

COUNTY

COUNTY

COUNTY

NA

CAROLINA ACCESS

COUNTY

COUNTY

COUNTY

COUNTY

COUNTY

CERT FROM AND THRU

SDX

SDX

NA

SDX

NA

CITIZEN/

IDENTITY

SDX/COUNTY

SDX/COUNTY

SDX/

COUNTY

SDX/

COUNTY

SDX/COUNTY

COUNTY NUMBER

SDX

COUNTY

COUNTY

COUNTY

COUNTY

DISTRICT

SDX

COUNTY

COUNTY

COUNTY

COUNTY

INCOME

SDX

COUNTY

COUNTY

COUNTY

COUNTY

LIVING ARRANGEMENT CODE

SDX/COUNTY

COUNTY

COUNTY

COUNTY

COUNTY

MAINTENANCE

SDX

COUNTY

COUNTY

COUNTY

COUNTY

MEDICAID CLASS

SDX

SDX

SDX

COUNTY

COUNTY

MEDICAID STATUS-(A)

SDX

SDX

SDX

SDX

SDX

PML

NA

COUNTY

COUNTY

COUNTY

NA

TPR

COUNTY

COUNTY

COUNTY

COUNTY

COUNTY

WORKER NUMBER

SDX/COUNTY

COUNTY

COUNTY

COUNTY

COUNTY

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

Top Of Page

III. SDX CHANGES

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

Top Of Page

IV. ALLOWABLE COUNTY CHANGES

    A. MAABD-PLA

      The county can make the following changes for an MAABD-PLA SSI case:

      1. Post and/or terminate CAP coverage.
      2. Enter or change a Carolina Access Provider/Exempt number.
      3. Change the LIVING ARRANGEMENT to LTC and post PML.
      4. Change the AID PROGRAM/CATEGORY to HSF.
      5. Enter or change CITIZEN/ID code and date.
      6. Enter the REL TO PAYEE code if blank.

    B. MAABD-LTC

      The county controls all data on an SSI Medicaid MAABD-LTC case except the data listed in I. and II. above. The county can make the following changes:

      1. Change the address and/or county.
      2. Post and/or terminate CAP coverage.
      3. Change the MAINTENANCE, PML, and/or INCOME fields.
      4. Change the LIVING ARRANGEMENT to PLA.
      5. Change the AID PROGRAM/CATEGORY to HSF.
      6. Enter or change CITIZEN/ID code and date.
      7. Enter the REL TO Payee code if blank.

    C. HSF

      The county controls all data on an SSI Medicaid HSF case except the data listed in I. and II. above. The county can make the following changes:

      1. Change the address and/or county.
      2. Post and/or terminate CAP coverage.
      3. Change the MEDICAID CLASS, MAINTENANCE, PML, and/or INCOME fields.

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

IV.(CONT'D)

      4. Change the LIVING ARRANGEMENT.
      5. Change the AID PROGRAM/CATEGORY to MAABD.
      6. Change the MEDICAID CLASSIFICATION.
      7. Enter or change CITIZEN/ID code and date.
      8. Enter the REL TO PAYEE code if blank.

    D. Special Assistance

      The county controls all data on an SSI Medicaid SAA or SAD case except the data listed in I. and II. above.

    E. AAF (PAYMENT TYPE 5)

      The county controls all data on an SSI Medicaid AAF case except the data listed in I. and II. above.

      Refer to the Work First Manual for instructions regarding AAF (Payment type 5) case changes.

Top Of Page

V. INSTRUCTIONS FOR ALLOWABLE CHANGES

    A. KEYING AN 8125 TO CHANGE AN SSI MEDICAID CASE

      Key the 8125 according to instructions found in this section of the EIS Manual. SSI Medicaid cases are not allowed to have an 8125 placed on hold with errors or placed on hold by the worker. If you attempt to place an 8125 on hold for an SSI case, the message displays CANNOT PUT FORM ON HOLD-SSI CASE. PRESS PF5 TO ERASE THIS FORM.

    B. CAP

      Post CAP Special Coverage according to existing instructions. Refer to EIS 3101 for MAABD and HSF. Refer to EIS 3102 for SAA and SAD.

    C. Carolina Access

      Enter a Carolina Access Provider Code according to existing instructions.

    D. COUNTY TRANSFERS

      If the SSI Medicaid case is SAA, SAD, HSF, AAF or MAABD-LTC, the county may complete a county transfer, according to existing instructions. Refer to EIS 3500.

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

V.(CONT'D)

    E. IVD REFERRAL

      You may complete a referral to IVD for a child receiving SSI Medicaid, though you are not required to do so. The approval notice indicates the recipient should contact the IVD office for Child Support Enforcement Services. If the county chooses to complete the automated referral to IVD, the process is the same as for any other active case. Refer to EIS 4900, Part C.

    F. LIVING ARRANGEMENT

      1. MAABD-LTC to PLA
        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • WORKER NUMBER

        • COUNTY NUMBER

        • M AA, M AB, or M AD as the AID PROGRAM/CATEGORY

        • MEDICAID EFFECTIVE DATE-Must be the first day of the ongoing month.

        • LIVING ARRANGEMENT CODE

        • PML CODE and AMT-Enter * in P field to delete PML CODE and AMT.

        b. EIS enters the following data:

        • ADDRESS from the SDX

        • CASEHEAD NAME from the SDX

        • CERTIFICATION THRU-12/31/9999

        • COUNTY NUMBER from the SDX

        • DISTRICT NUMBER-SDX

        • INCOME from the SDX

        • MEDICAID CLASS based on SDX data-C or Q

        • MEDICAID STATUS-A

        • PAYMENT TYPE-9

        • SSI STATUS-Y

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

V.F.(CONT'D)

      2. MAABD-PLA to LTC
        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • WORKER NUMBER

        • COUNTY NUMBER

        • DISTRICT NUMBER

        • M AA, M AB, or M AD as the AID PROGRAM/CATEGORY

        • ADDRESS

        • CHANGE CODE 50 (Key a text message)

        • MEDICAID EFFECTIVE DATE-Must be the first day of the ongoing month.

        • PML CODE and AMOUNT

        • LIVING ARRANGEMENT CODE

        b. EIS enters the following data:

        • CASEHEAD NAME from the SDX

        • Certification THRU-12/31/9999

        • INCOME from the SDX

        • MEDICAID CLASS based on SDX data-C or Q

        • Medicaid Status-A

        • Payment type-9

        • SSI STATUS-Y

    G. PROGRAM TRANSFERS

      1. MAABD TO SAA OR SAD-This is a reapplication. Refer to the SA Policy Manual for instructions.

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

V.G.(CONT’D)

      2. SAA OR SAD TO MAABD-PLA

        NOTE: All SA TO MAABD NOTICES ARE MANUAL.

        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • WORKER NUMBER

        • COUNTY NUMBER

        • M AA, M AB, or M AD as the AID PROGRAM/CATEGORY.

        • Delete the DOM FACILITY CODE.

        • Enter another FACILITY CODE, if needed.

        • MEDICAID EFFECTIVE DATE-Must be the first day of the on-going month.

        • LIVING ARRANGEMENT CODE

        b. EIS enters the following data:

        • ADDRESS from the SDX

        • CASEHEAD NAME from the SDX

        • CERTIFICATION THRU-12/31/9999

        • COUNTY NUMBER from the SDX

        • DISTRICT NUMBER-SDX

        • INCOME from the SDX

        • MAINTENANCE-zeroes

        • MEDICAID CLASS based on SDX data-C or Q

        • MEDICAID STATUS-A

        • PAYMENT TYPE-9

        • SSI STATUS-Y

        c. EIS deletes the following data:

        • COUNTY CASE NUMBER

        • PAYMENT DATA

        • PAYMENT REVIEW PERIOD

        • GRANT RECOUPMENT

        • DOMICILIARY RATE

REVISED 03/01/99 - CHANGE NO. 10-99

V.G.(CONT’D)

        • AMBULATION CAPACITY

        • INDIVIDUAL Income fields

      3. SAA, SAD, HSF, AAF TO MAABD-LTC
        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • DISTRICT NUMBER

        • WORKER NUMBER

        • COUNTY NUMBER

        • M AA, M AB, or M AD as the AID PROGRAM/CATEGORY

        • ADDRESS

        • Delete the DOM FACILITY CODE, if present.

        • Enter another FACILITY CODE, if needed.

        • MEDICAID EFFECTIVE DATE-Must be the first day of the on-going month.

        • Enter the CERT FROM DATE.

        • PML CODE and AMOUNT

        • MAINTENANCE AMOUNT

        • INCOME

        • LIVING ARRANGEMENT CODE

        b. EIS enters the following data:

        • CASEHEAD NAME from the SDX

        • CERTIFICATION THRU-12/31/9999

        • MEDICAID CLASS based on SDX data-C or Q

        • MEDICAID STATUS-A

        • PAYMENT TYPE-9

        • SSI STATUS-Y

        c. EIS deletes the following:

        • PAYMENT DATA

        • PAYMENT REVIEW PERIOD

        • GRANT RECOUPMENT

REVISED 03/01/99 - CHANGE NO. 10-99

V.G.(CONT’D)

        • DOMICILIARY RATE

        • AMBULATION CAPACITY

        • INDIVIDUAL Income fields

        • WORK EXPERIENCE

        • EDUCATION LEVEL

        • JOBS/WORK REGISTRATION

      4. HSF TO MAD-PLA OR MAB-PLA
        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • WORKER NUMBER

        • COUNTY NUMBER

        • M AB or M AD as the AID PROGRAM/CATEGORY

        • MEDICAID EFFECTIVE DATE-Must be the first day of the on-going month.

        • LIVING ARRANGEMENT CODE

        b. EIS enters the following data:

        • ADDRESS from the SDX

        • CASEHEAD NAME from the SDX

        • CERTIFICATION THRU-12/31/9999

        • COUNTY NUMBER from the SDX

        • DISTRICT NUMBER-SDX

        • INCOME from the SDX

        • MAINTENANCE-zeroes

        • MEDICAID CLASS based on SDX data-C or Q

        • MEDICAID STATUS-A

        • PAYMENT TYPE-9

        • SSI STATUS-Y

REVISED 03/01/99 - CHANGE NO. 10-99

V.G.(CONT’D)

      5. AAF TO MAD-PLA OR MAB-PLA
        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • WORKER NUMBER

        • COUNTY NUMBER

        • M AB or M AD as the AID PROGRAM/CATEGORY

        • MEDICAID EFFECTIVE DATE-Must be the first day of the on-going month.

        • LIVING ARRANGEMENT CODE

        b. EIS enters the following data:

        • ADDRESS from the SDX

        • CASEHEAD NAME from the SDX

        • CERTIFICATION THRU-12/31/9999

        • COUNTY NUMBER from the SDX

        • DISTRICT NUMBER-SDX

        • INCOME from the SDX

        • MAINTENANCE-zeroes

        • MEDICAID CLASS based on SDX data-C or Q

        • MEDICAID STATUS-A

        • PAYMENT TYPE-9

        • SSI STATUS-Y

        c. EIS deletes the following data:

        • COUNTY CASE NUMBER

        • PAYMENT DATA

        • INDIVIDUAL INCOME

        • WORK EXPERIENCE

        • EDUCATION LEVEL

        • JOBS/WORK REGISTRATION

REVISED 03/01/99 - CHANGE NO. 10-99

V.G.(CONT’D)

      6. MAABD TO HSF
        a. Complete a DSS-8125 transaction. Enter the following data:

        • CASE ID

        • WORKER NUMBER

        • DISTRICT NUMBER

        • COUNTY NUMBER

        • COUNTY CASE NUMBER

        • H SF as the AID PROGRAM/CATEGORY

        • MEDICAID EFFECTIVE DATE-Must be the first day of the on-going month.

        • MAINTENANCE

        • MEDICAID CLASS

        • LIVING ARRANGEMENT CODE

        b. EIS enters the following data:

        • CASEHEAD NAME from the SDX

        • CERTIFICATION THRU-12/31/9999

        • INCOME from the SDX

        • MEDICAID STATUS-A

        • PAYMENT TYPE-9

        • SSI STATUS-Y

    H. Third Party insurance

      If the county becomes aware of Third Party Insurance, enter a DMA-2041 according to existing instructions, OR have the client report the information to DMA, Third Party Recovery Section.

Previous PageTop Of PageNext Page



 


View Manual in PDF      DHHS Manual Home Manual Admin Letters Change Notices Archive Search Index Help Feedback