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I. GENERAL INFORMATION

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1. WORK FIRST USER S MANUAL Change 42 2012 MEDICAID COVERAGE PROCEDURES November 1 2012 WF1500 MEDICAID COVERAGE PROCEDURES Change 42 2012 Issued November 1 2012 WF1500 01 DEDUCTIBLE BALANCE PATIENT MONTHLY LIABILITY SCREEN SP DB PML If a replacement Medicaid card must be issued use the DB PML screen The link is below http info dhhs state nc us olm manuals dma eis man Eis3105 htm P13 362 WF1501 MANAGED CARE HMO WF1501 01 GENERAL INFORMATION Health Maintenance Organizations HMO s are Medicaid managed care programs utilized by the Division of Medical Assistance to link recipients with a medical provider who is responsible for providing and coordinating their health care needs Managed care improved access to medical care for recipients and provides a more effective medical delivery system for the sate and county Mecklenberg County s Medicaid managed care program Health Care Connection is the primary medical delivery system for Work First recipients who reside in Mecklenberg County Health Care Connection contracts with licensed HMO s and Carolina ACCESS providers to manage and coordinate their health care needs Therefore in Mecklenberg County only Work First recipients have the option of enrolling with an HMO or Carolina ACCESS provider There are special circumstances where an individual s medical needs may be better met outside of the managed care program If so the individual may be exempt from parti
2. HMO unless the case is changing to another HMO or Carolina ACCESS NOTE For individuals with a Citizen ID code of 60 through 66 EIS automatically enters a Carolina ACCESS Exempt Number of 9999901 Caseworkers are responsible for educating recipients when they make an application for Medicaid Caseworkers will ask recipients to complete a Medicaid Managed Care enrollment form during the application process WF1500 WORK FIRST USER S MANUAL Change 712 2008 MEDICAID COVERAGE PROCEDURES July 1 2008 Caseworkers will place the completed enrollment forms in the appropriate place as designated by DSS Caseworkers will refer recipients to PCG for follow up managed care education and enrollment as necessary Caseworkers are responsible for recipient education at re certification Recipients should contact PCG when changing Providers or Health Plans E DMA s Responsibilities DMA will provide PCG with access to EIS DMA will provide PCG with Mecklenburg County Medicaid managed care enrollment tapes including HMO Carolina ACCESS enrollment and exemptions F Steps for Educating and Enrolling Recipients in Managed Care At Application or Re Certification Step 1 Educate the applicants recipients about HMO s and CAROLINA ACCESS Step 2 Give each applicant recipients an HMO Carolina ACCESS Recipient Handbook and point out the plan comparison charts Step 3 Let applic
3. and b The Medicaid Effective Date equals the month of birth and C Mom s HMO begin date is prior to or equal to the newborn s month of birth Otherwise EIS uses the ongoing month as the HMO begin date B Work First Family Assistance Reopen Change Code 99 1 If a family with HMO coverage is reopened using change code reason 99 and the family still qualifies for the HMO EIS will re enroll automatically the family members in the HMO 2 The effective date is the Medicaid Effective Date on the reopen C Aid Program Category Transfer If a family transfers to Medicaid MAF MIC or MPW and the certification period is more than 2 months EIS automatically closes the HMO managed care segment effective the end of the last month of eligibility D Case Termination If a Work First Family Assistance case with HMO coverage is terminated EIS inserts automatically the case termination date in the HMO MANAGED CARE SEGMENT END DATE field for all individuals in the case WF1500 WORK FIRST USER S MANUAL Change 712 2009 MEDICAID COVERAGE PROCEDURES October 1 2009 E Individual Deletion 1 If an individual is deleted from a Work First Family Assistance or 2 month continuation MAF MIC MPW case with active HMO coverage EIS inserts automatically the individual delete date in the HMO MANAGED CARE SEGMENT END DATE FIELD 2 HMO coverage for the individuals remaining on the case continues WF1501 10 DB PM
4. individual on the case If the individual is exempt because he has Medicare EIS creates an exempt managed care segment using exempt 9099503 When EIS creates a Medicare exempt managed care segment for all individuals on the case the EIS Input Menu is displayed with the following message CASE FORM EXEMPTED FROM HMO MEDICARE A B When there is at least ONE HMO qualified individual on the case EIS displays the screen again with new messages at the bottom PRESS ENTER TO CONTINUE ENROLLMENT PROCESS USE PF3 TO ASSIGN EXEMPT NUMBER 9999903 TO INDIVIDUALS ON CASE EJA992S1 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES EJA992 ELIGIBILITY INFORMATION SYSTEM 00 00 00 MANAGED CARE ENROLLMENT SCREEN CASE ID FORM ID CATEGORY CODE SELECT 00000000 HMOM PF2 RETURN TO INQUIRY MENU PLEASE SELECT THE TYPE OF ENROLLMENT WF1500 WORK FIRST USER S MANUAL Change 1 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 E At this point you have the following options 1 To discontinue the enrollment process and return to the EIS Input Menu press PF2 Any exempt managed care segments created on line are not deleted 2 PF3 is not a valid option at initial enrollment It is valid only for disenrolling families from the HMO DO NOT USE PF3 AT INITIAL ENROLLMENT 3 To continue the enrollment process press ENTER When you press ENTER EIS displays the HMO qualified individuals 1 at a time The followi
5. is currently enrolled in an HMO Note the HMO ENROLLED message at the bottom of the screen EIS INDIVIDUAL ELIGIBILITY HISTORY FOR 000000000X HIST FROM AUTH FROM HIST THRU PGM CLS SSI CO PAY CASEID LIV CD DB PMLCOV SUBPGM CDE FPL AMB SN PCHP PROVDRNUM AUTO RSN DIST 00 00 0000 00 00 000 00 00 0000 AAF N N 60 00000000 10 SELECTION KEY 000000000X 607 PRESS PA1 KEY FOR NEXTSCREEN HMO ENROLLED WF1501 09 CASE INDIVIDUAL CHANGES AND HMO EIS continues or closes automatically the HMO managed care segment in certain situations The following changes occur in the nightly update The managed care segments are available for inquiry the next workday n WF1500 WORK FIRST USER S MANUAL Change 1 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 A Add An Individual Inclusion 1 When adding an individual 7 months or older to a case currently enrolled in the HMO EIS creates a managed care segment with the ongoing month as the begin date a If the individual has Medicare the managed care segment indicates exempt due to Medicare 9999903 b If the individual does not have Medicare the managed care segment indicates the HMO 2 When adding a newborn 6 months or less to a case currently enrolled in the HMO and the newborn qualified for Mom s HMO EIS builds the managed care segment with the birth month as the begin date when a The newborn has not received Medicaid in another aid program category
6. Cases 99 99 9 2 Managed Care Categories CARX OR SPACE CAROLINA ACCESS HMOM HMO MEDICAL D The following is an example of what the information looks like for a managed care provider WF1500 WORK FIRST USER S MANUAL Change 712 2004 MEDICAID COVERAGE PROCEDURES August 9 2004 EJA939S1 NC DEPT OF HEALTH AND HUMAN SERVICES EJA939 MANAGED CARE PROVIDER DATABASE PROV OLD PROV MANAGED CARE CATEGORY HMOM CAROLINA ACCESS IND N CAROLINA ALT NUMBER HOSPITAL PRIVILEGES OFFICE HOURS PVDR ADMN AFTER HOURS CODE GROUP INDIVIDUAL PROVIDER LAST FIRST MI SPECIALTY CODE 02 SITE NAME LOCATION CLINIC LINE 1 LINE 2 CITY STATE NC ZIP CODE COUNTY OFFICE PHONE AFTER HOURS COUNTIES BEING SERVED 60 RESTRICTIONS PATIENT ASSIGNMENT MAXIMUM 99999 CURRENT 00001 CA CONTACT PERSON FIRST LAST MI PARTICIPATION DTES MMDDCCY Y FROM 0000000 THRU 00000000 LAST CHG 00000000 PF2 14 MENU PF3 15 ADD PVDR PF4 16 NOTEPAD PF5 17 XREF PF6 18 SCREEN2 WF1501 08 A Restrictions It is very important to verify the restrictions on the MP screen to link the recipients appropriately The restrictions are listed below 01 No Restriction 02 Established patients only 06 MPW only 07 Nephology patients only in same or contiguous counties only 08 Chronic infectious disease only in same or contiguous counties only 09 Oncology patients only 10 Established patients amp siblin
7. L SCREEN AND HMO When posting retroactive Medicaid for a newborn 6 months old or less using the DB PML screen and mom was HMO enrolled during the same retro period EIS creates an open shut managed care segment same HMO as mom WF1501 11 MEDICAID ID CARDS FOR HMO ENROLLEES A Currently displayed on all Medicaid ID cards 1 Each individual enrolled in an HMO receives a separate Medicaid ID card mailed in its own envelope 2 EIS prints the following HMO information on the Medicaid ID card 3 Above the name and address of the individual EIS prints PREPAID HEALTH PLAN ENROLLEE B If the case is disenrolled Medicaid from Date on the card changes to the first day of the month following the end date on the managed care segment MEDICAID IDENTIFICATION CARD SEE INSTRUCTIONS ON BACK N C DEPT OF HEALTH AND HUMAN SERVICES DIVISION OF MEDICAL ASSISTANCE VALID CAP COUNTY CASE NO INSURANCE PROGRAM CLASS FROM THRU 000000 X XXX X 00 00 00 00 00 00 RECIPIENT I D ELIGIBLE FOR MEDICAID INS NO BIRTHDATE SEX 000000000X XXXXXXXXXX X XXXXXXXXX XXXXXX 00 00 00 X INSURANCE DATA PREPAID HEALTH PLAN ENROLLEE 00 000000 XXX 00000000 IINS NO NAMECODE POLICY NUMBER TYPE XXXXXXXXXX X XXXXXXXXXXXXXXX XXXXXXXXXXXXXXX XXXXXXXXXXXX NC 00000 RECIPIENT NOT VALID UNLESS SIGNED MISUSE MAY RESULT IN FRAUD PROSECUTION SIGNATURE WF1500 WORK FIRST USER S MANUAL Change 712 2009 MEDICAID COVERAGE PROCEDURES Oct
8. MEDICAID COVERAGE PROCEDURES April 1 2003 2 You have the following options a Todiscontinue the process and return to the EIS Input Menu press PF2 b Family Eligible for HMO but Requests Disenrollment To disenroll a family from HMO and assign the temporary exempt number 9999903 family qualifies for HMO enter Y beside the question DO YOU WISH TO CHANGE and press PF3 EIS closes the existing managed care segment and creates a temporary exempt managed care segment for each HMO qualifying individual in the family EIS displays the EIS Input Menu with the following message INDS HAVE EXEMPT MANAGED CARE SEGS CREATED c Instructed By DMA to Disenroll Case for Cause To disenroll a case for cause enter Y beside the question DO YOU WISH TO CHANGE and press ENTER On the next screen press PF5 Key the exempt number 9099502 under ELIGIBLE PROVIDERS S under SELECT and press PF5 again EIS closes the existing HMO managed care segment and creates an exempt segment with the 9999903 number The next individual appears Repeat this PF5 process for each individual until all individuals on the case are disenrolled d Todisenroll a case from HMO that was enrolled in error recipients who do not qualify for the HMO enter Y beside the question DO YOU WISH TO CHANGE On the next screen press PF5 Key the exempt number 9099507 under ELIGIBLE PROVIDERS S under SELECT and p
9. ant recipient review the Medicaid Provider Directory to choose a Health Plan and or provider Step 4 Complete each area of the Managed Care Enrollment Form Step 5 When completed place the Managed Care Enrollment form in the appropriate place as designated by DSS Step 6 Refer applicants recipients to PCG to address special needs or health care provider concerns Step 7 Assign CS HMO exempt numbers 9900030 or the appropriate managed care exempt number when the application is made approved G Accessing the Enrollment Screen Using the ME Selection To access the Managed Care Enrollment screen use the following instructions WF1500 WORK FIRST USER S MANUAL Change 1 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 1 To display the Managed Care Enrollment screen from the EIS Input Menu enter ME in the SELECTION field and the case ID or form ID in the KEY field NOTE You may enter the ME selection from any screen in EIS that displays the SELECTION and KEY fields a When enrolling or disenrolling active Work First Family Assistance families use the case ID number to request the enrollment screen b When the DSS 8125 has been keyed error free to approve the application and later the same day you want to enroll the case use the DSS 8125 form ID number to request the enrollment screen NOTE You will not be allowed to use the ME selection when there is a DSS 8125 form on hold 2 EIS wi
10. choose a Carolina ACCESS provider for each person on your application 2 If you have not seen this provider before you should call right away to set up your medical record 3 You must see this provider for checkups and when you are sick 4 If you think you need to see any other doctor you must get the visit approved by your Carolina ACCESS provider first 5 If you see another doctor without an approval from your Carolina ACCESS provider Medicaid will not pay for the visit 6 If his office is closed and care cannot wait until the office reopens your Carolina ACCESS provider has an after hours number 7 Only go to the Emergency Room for true life threatening conditions like severe bleeding broken bones trouble breathing or chest pains 8 Medicaid will not pay for non emergency treatment in the Emergency Room unless your Carolina ACCESS provider has approved the visit 9 If you are not sure that your visit to the Emergency Room will be approved call your Carolina ACCESS provider before you go 10 You can change Carolina ACCESS providers Call your case manager or the Carolina ACCESS representative to find out when you can make a change B Contact your local Carolina ACCESS plan representative with any questions or special situations WF1502 01 HOW TO ENTER THE CAROLINA ACCESS CODE You must key a DSS 8125 8126 to enter update a Carolina ACCESS Code in the field under Individual Data Key the 7 digit provider numbe
11. cipating in the managed care program to meet his or her medical needs WF1501 02 HMO POLICY HMO s are managed health care programs available for families receiving Work First who reside in Mecklenberg County only Recipients are linked with a primary care provider who provides or coordinates needed medical services A Only Work First Family Assistance families in Mecklenberg County may enroll All individuals in a family must enroll unless otherwise exempt The individual still has the option of using regular Medicaid coverage for services that are not covered by the HMO However all services included in the managed care program must be obtained from the recipients primary care provider or referral source WF1500 WORK FIRST USER S MANUAL Change 1 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 D Enrollment continues through the end of the Work First Family Assistance certification period Enrollment is effective the ongoing month in EIS However there are 2 exceptions to this rule 1 For Work First reopens Change Code 99 enrollment is retroactive to the reopen date 2 For newborn 6 months old or less approvals enrollment is retroactive to the birth month if the mother was enrolled in the HMO at that time and the baby qualified A family can voluntarily request disenrollment from the HMO However the family must enroll in Carolina ACCESS unless exempt Otherwise the family remains in th
12. e HMO until 1 The case is terminated 2 The case is transferred to another aid program category certification more than 1 month 3 The case is transferred to another county or 4 DMA approves the involuntary disenrollment of a case WF1501 03 HMO ON LINE ENROLLMENT Use the on line enrollment screen in EIS IMPORTANT Enter only Medicaid HMO enrollment using the on line Managed Care screens Continue to enter private HMO information and other third party insurance information into the TPR database using the DMA 2041 There are 2 mechanisms through which EIS will display the Managed Care Enrollment screen A Automatically through the DSS 8125 process and At caseworker request using the ME Selection in EIS Accessing The Enrollment Screen Through The DSS 8125 HMO enrollment is voluntary for Mecklenburg County Thereafter EIS will not display automatically the Managed Care Enrollment screen from the DSS 8125 Mecklenburg County caseworkers use the ME Selection in EIS to enroll Work First Family Assistance families in an HMO WF1500 WORK FIRST USER S MANUAL Change 712 2008 MEDICAID COVERAGE PROCEDURES July 1 2008 Policy Regarding Client Education and Enrollment Recipient education and enrollment in Mecklenburg County is the responsibility of Public Consulting Group PCG the County Department of Social Services Eligibility Caseworkers and DMA Public Consulting Group is considered t
13. gn the code during the nightly update process Changes To a Carolina ACCESS Code The Carolina ACCESS Provider Code can be changed anytime the individual changes providers The Provider Code can also be changed to an exempt code if applicable The change is effective the ongoing month To remove the Carolina ACCESS code press the delete key on the C A field WF1500 WORK FIRST USER S MANUAL Change 712 2009 MEDICAID COVERAGE PROCEDURES October 1 2009 G Pull Reissue After the regular run for each aid program category any changes to the Carolina ACCESS Code going from coverage to no coverage or no coverage to coverage causes a pull reissue Changes for coverage to coverage changing the Provider Code does not cause a pull reissue WF1503 THIRD PARTY RECOVERY http info dhhs state nc us olm manuals dma eis man Eis3350 htm P12 315 WF1504 1634 PROCEDURES http 149 168 11 112 80 olm manuals dss ei 50 man WF206 01 htm WF1500
14. gs 11 Newborn only 14 Two track clinics facilities serving two distinct populations 15 Age restrictions refer to Notepad PF4 16 on MP Screen INDIVIDUAL AND MEDICAID ELIGIBILITY HISTORY INQUIRY ID Inquiry The following is an example of an ID screen for an individual who is currently enrolled in an HMO Note the HMO ENROLLED message at the bottom of the screen ie WF1500 WORK FIRST USER S MANUAL Change 712 2012 MEDICAID COVERAGE PROCEDURES November 1 2012 EJA911 INDIVIDU AL INQUIRY SCREEN DATE 09 01 2009 ID 00000000X NAME xxxxxxx XXXXXXX DATE OF BIRTH 00 00 0000 STATUS INCASER SSN 000000000 DATEOF DEATH FAMILY STATUS C RSDI CLAIM NO SEX X LIVINGARR 10 PVDR NUMBER 9999905 RACE XXXXX REF CODE DATE 0000 00 TPR INS TYPE ETHNICITY X ALIEN ID CITIZEN ID LANGUAGE DIS GROSS EARN 00000 00 WORK REGISTRA EMP amp TRAIN CHILD ADULT 00000 00 SPEC RPT EMP amp TRAN DATE 0000 00 WORK EXPEN 00000 00 ED LEVEL MEDICARE DATE NET EARN 00000 00 ED EMPL MEDICARE A INV IND MEDICARE B WF JOB BONUS HMO ENROLLED Y EPICS CLAIM N MA JOB BONUS REL TO PAYEE PACE ENROLLED CREATEDATE 00 00 0000 LATEST CASE ID 00000000 LATEST FORM ID 0000000B TERM DATE LATEST COUNTY 60 LATES T DTE UPDT 2002000 CRD ISSUE DTE SEL KEY 000000000X INQUIRY IS COMPLETE PF6 CASE PF5 MED ABC PF4 MED D PF9 INDV PROFILE B Medicaid Eligibility History Inquiry The following is an example of a Medicaid Eligibility History screen for an individual who
15. ll display the enrollment screen with the case or form ID and the Category Code HMOM EJA992S1 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES EJA992 ELIGIBILITY INFORMATION SYSTEM 00 00 00 MANAGED CARE ENROLLMENT SCREEN CASE ID FORM ID CATEGORY CODE SELECT 00000000 HMOM PF2 RETURN TO INQUIRY MENU PLEASE SELECT THE TYPE OF ENROLLMENT WF1501 04 MANAGED CARE ENROLLMENT SCREEN INSTRUCTIONS The Managed Care Enrollment screen process is basically the same whether you request the screen using the ME selection or EIS displays automatically the screen off the DSS 8125 Where there are differences they are noted in the following instructions WF1500 WORK FIRST USER S MANUAL Change 1 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 WF1501 05 A INITIAL HMO ENROLLMENT On the first Managed Care Enrollment screen you have the following options 1 To discontinue the enrollment process and return to the EIS Input menu press PF2 REMEMBER If you entered the enrollment screen through the DSS 8125 PF2 puts the DSS 8125 on hold 2 To continue the enrollment process enter S in the SELECT field on the Managed Care Enrollment screen EIS checks to ensure that the payment type on the case is valid for the HMO NOTE If you enter the enrollment screen through the DSS 8125 EIS completes this edit before leaving the DSS 8125 form If the payment type is valid EIS examines each
16. ng screen illustrates the information that is displayed EJA940S1 NORTH CAROLINA DEPARTMENT OF HUMAN SERVICES EJA940 ELIGIBILITY INFORMATION SYSTEM 00 00 00 MANAGED CARE ENROLLMENT SCREEN CASE ID 00000000 FORM ID CATEGORY CODE HMOM CHANGE AUTO INDIVIDUAL ID PERIOD ELIGIBLE PROVIDERS SELECT REASON ASSIGN 000000000X 00 00 0000 00 00 0000 0000000 0000000 EIS lists EIS fills EIS fills in EIS lists all the individual in the zeros for AAF or the HMOs ID of 1 1st day Medicaid Cert for which the person at a of the Thru for Medicaid person time Ongoing continuation cases qualifies month PF2 INQUIRY MENU PLEASE SELECT A PROVIDER F On this screen you have the following options 1 To discontinue the enrollment process and return to the EIS Input Menu press PF2 Any exempt managed care segments created on line are not deleted 2 PF3 is not a valid option at initial enrollment It is valid only for disenrolling families from the HMO DO NOT USE PF3 AT INITIAL ENROLLMENT WF1500 Change 1 2003 WORK FIRST USER S MANUAL MEDICAID COVERAGE PROCEDURES April 1 2003 3 PF5 is not a valid option at initial enrollment It is valid only for disenrolling families from the HMO DO NOT USE PF5 AT INITIAL ENROLLMENT To select the HMO chosen by the individual key S in the SELECT field At this time there is only 1 However the selection option is built into the system design in anticipati
17. o be the lead agency with regard to recipient education and enrollment However potential Medicaid eligibles should be educated about managed care by their caseworker during the initial point of contact which is normally when the individual makes an application Recipients should also be provided managed care education at the time of their re certification for Medicaid PCG s Responsibilities PCG s education efforts will be concentrated through telephone contact and mail upon receipt of the managed care enrollment form PCG is responsible for educating recipients about the managed care programs and how they work PCG will help recipients to select a provider from the Mecklenburg County Medicaid Managed Care Provider Directory PCG will help recipients complete the Managed Care Enrollment Form PCG will enter managed care information from the enrollment form into the EIS via the DSS 8125 PCG will provide follow up education to recipients as necessary PCG will automatically link Medicaid recipients to a Health Plan when recipients do not make a selection within a reasonable timeframe Eligibility Caseworker s Responsibilities Caseworkers will key 9900030 or the appropriate managed care exempt number in the Carolina ACCESS field of the DSS 8125 when the application is made approved For add an individual application approval to a case enrolled with an HMO the individual being added must be enrolled with the same
18. ober 1 2009 WF1501 12 HMO REPORTS A EIS produces two monthly reports in NCXPTR 1 Exempt Report DHREJ EXEMPT PVDR CODE REPORT 2 SSI Exempt Report DHREJ SSI EXEMPT MEDICARE REPORT B The reports are sorted by 1 County Number 2 Exempt Number GENERAL INFORMATION 3 Caretaker Name Last Name First Name Middle Initial EJA796Z1 NC DEPARTMENT OF HEALTH AND HUMAN SERVICES ELIGIBILITY INFORMATION SYSTEM PAGE 000 RUN DATE MM DD CCYY RUN TIME 00 00 00 HMO EXEMPT REPORT COUNTY NUMBER 00 XXXXXX XXXXXXXXXXXXXXXXXXXXXX DIST NO CNTY CASE NO WORKER NO XXX XXXXXX XXX CASE ID AID PGM CAT CASEHEAD NAME CASEHEAD ADDRESS PHONE NUM 00000000 XXX XXXXXX XXXXX XXXXXXXXXXX 0000000000 INDIVIDUAL ID INDIVIDUAL NAME EXEMPT NUMBER XXXXXXXXXX XXXXXXXXX X XXXXXXXXXXX 000000X CASE ID AID PGM CAT CASEHEAD NAME CASEHEAD ADDRESS PHONE NUMBER 00000000 XXX XXXXXXX XXXXX XXXXXXXXXXXX 0000000000 INDIVIDUAL ID INDIVIDUAL NAME EXEMPT NUMBER XXXXXXXXXX XXXXXXXXXXX X XXXXXXXXXXX 000000X END REPORT WF1502 CAROLINA ACCESS Carolina ACCESS is a managed health care program for families receiving Medicaid Members are linked with a primary care provider who delivers or coordinates needed medical services A Explain the program to Work First Family Assistance families Make sure to cover the following points WF1500 Change 52 2009 WORK FIRST USER S MANUAL MEDICAID COVERAGE PROCEDURES October 1 2009 1 You must
19. on of future HMO s When you select this option EIS creates an HMO managed care segment for the individual and displays the next HMO eligible individual NOTE Once you have pressed the ENTER key to enroll the first individual you must complete the enrollment process for all remaining individuals on the case You are not allowed to use any of the PF keys after 1 of the individuals on the case is enrolled You will get the following error message ENROLLMENT DISENROLLMENT PROCESS STARTED MUST COMPLETE FOR CASE EIS continues with this process until all qualifying individuals in the family are enrolled When the last individual is enrolled EIS displays the first Managed Care Enrollment screen with zeros as the case ID The message at the bottom of the screen reads PLEASE ENTER CASE ID OR FORM ID From this screen you may complete a new enrollment for a subsequent case or press PF2 to return to the EIS Input Menu G Changes in HMO Enrollment 1 If the family has existing ongoing HMO or exempt managed care segments and you request the enrollment screen using the ME Selection in EIS and key S to select HMOM the following messages are displayed at the bottom of the enrollment screen PF2 RETURN TO INQUIRY MENU CASE HAS MANAGED CARE EXEMPT NUMBER 9999999 DO YOU WISH TO CHANGE USE PF3 KEY TO ASSIGN EXEMPT NUMBER 9999903 TO INDIVIDUALS ON CASE WF1500 WORK FIRST USER S MANUAL Change 1 2003
20. r A Carolina ACCESS C A Code is required for NOTE For individuals with a Citizen ID code of 60 through 66 EIS automatically enters a Carolina ACCESS Exempt Number of 9999901 WF1500 WORK FIRST USER S MANUAL Change 712 2009 MEDICAID COVERAGE PROCEDURES October 1 2009 A Application Approval A C A code is required for each individual that will be in the ongoing case Add An Individual Approval Authorized Cases 1 A C A code is required for each individual that is being added to an ongoing case 2 A C A code cannot be entered for the other individuals in the case at the same time the application approval is entered 3 If a C A code is to be entered on the other individual s in the case a separate DSS 8125 and DSS 8126 if necessary needs to be entered the day after the add approval is keyed Review Redetermination Authorized Cases A C A code is required for each individual in the case Once the Carolina ACCESS code has been entered it does not have to be reentered at each review Program Transfer Cases that already have a Carolina ACCESS Provider Code that transfer to an aid program category that requires a Provider Code require no change Cases that already have a Carolina ACCESS Provider Code that transfer to an aid program category that does not allow a Provider Code must have the Provider Code removed The exempt code 9999901 can be entered or the system will assi
21. ress PF5 again EIS closes the existing HMO managed care segment and creates an exempt segment with the 9099507 number The next individual appears WF1500 WORK FIRST USER S MANUAL Change 1 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 Repeat this PF5 process for each individual until all individuals on the case are disenrolled e To enroll a temporarily exempt family in the HMO enter Y beside the question DO YOU WISH TO CHANGE and press ENTER Complete the screen to enroll the family in the HMO EIS closes the existing exempt managed care segments and creates HMO managed care segments for the family WF1501 06 MANAGED CARE HISTORY INQUIRY A To view a HMO or exempt managed care segment enter MI in the SELECTION field and the individual ID in the KEY field NOTE You may enter the MI selection from any screen in EIS that displays the SELECTION field B The Managed Care History Inquiry screen appears EJA948 1 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DATE 00 00 00 ELIGIBILITY INFORMATION SYSTEM TIME 00 00 00 MANAGED CARE HISTORY INQUIRY INDIVIDUAL 000000000X PROVIDER CATGRY PROVIDER CASE CNTY FROM TO CG AU NUMBER CODE NAME ID NO DATE DATE RSAS SELECTION MI KEY PF2 14 MENU PF7 19 BACKWARD PF8 20 FORWARD C EIS will move the cursor to the INDIVIDUAL field at the top of the screen To view a managed care segment for a subsequent individual you may key
22. the new individual ID number without moving the cursor WF1501 07 MANAGED CARE PROVIDER DATA INQUIRY A To view the information for a managed care provider or exempt number key MP in the SELECTION field B The Managed Care Provider Database screen appears as follows WF1500 WORK FIRST USER S MANUAL Change 711 2003 MEDICAID COVERAGE PROCEDURES April 1 2003 EJA939S1 NC DEPT OF HEALTH AND HUMAN SERVICES EJA939 MANAGED CARE PROVIDER DATABASE PROV OLD PROV MANAGED CARE CATEGORY CAROLINA ACCESS IND CAROLINA ALT UB92 NUMBER HOSPITAL PRIVILEGES OFFICE HOURS PVDR ADMN AFTER HOURS CODE GROUP INDIVIDUAL PROVIDER LAST FIRST MI SPECIALTY CODE SITE NAME LOCATION CLINIC LINE 1 LINE 2 CITY STATE ZIP CODE COUNTY OFFICE PHONE AFTER HOURS COUNTIES BEING SERVED RESTRICTIONS PATIENT ASSIGNMENT MAXIMUM 00000 CURRENT CA CONTACT PERSON FIRST LAST MI PARTICIPATION DTES MMDDCCYY FROM THRU 00000000 LAST CHG PF2 14 MENU PF3 15 ADD PVDR PF4 16 NOTEPAD PF5 17ZXREF PF6 18 SCREEN2 PLEASE ENTER PROVIDER ID C Key the PROVIDER NUMBER and the MANAGED CARE CATEGORY T HMO Provider and Exempt Numbers 9999905 Recipient chooses HMO 9900030 Temporary Exemption 9900020 Temporary Medical Exemption State approval 9900021 Permanent Medical Exemption State approval 9900025 Recipient has other primary health insurance 9900045 Generated for approved Benefit Diversion

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