MEDS NETWORK USER MANUAL Appendices - lcdss home page

MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
ELIG
0190
1st Digit = Medi-Cal/CMSP/Other Eligible Status 0191
0
Full Scope Medi-Cal Eligible (includes zero SOC)
with no conditions (refer to 3 below for conditions)
1 Full Scope Medi-Cal LTC/SOC Eligible (i.e.,
Share
of Cost to be met by LTC claim)
2 LTC/SOC Eligible with one or more conditions
(refer to 3 below for conditions)
3
4
5
6
Eligible with one or more conditions - Certified
SOC, Restricted Services, Minor Consent, CMSP
Coverage, Limited Scope Medi-Cal Coverage
and/or Partial Health Care Plan (HCP) Coverage
Medi-Cal Eligible with Full Service Medi-Cal HCP
Coverage
Medi-Cal or CMSP Client with an Unmet Share of
Cost Obligation (Uncertified SOC)
Eligible for a Health or Welfare Program other
than Medi-Cal or CMSP services (i.e., SLMB,
QDWI, Out-of-State Foster Care, Unborn, Healthy
Families, County MI Program, CHDP State Only,
MCE State and County, HCCI Existing, HCCI New,
and AIM Pregnant Mother)
7
8
9
Hold
QMB pending Medicare part A & B confirmation
Ineligible
2nd Digit = Normal/Exception Eligibility
0
1
2
3
4
5
6
0192
Normal eligible
Unconfirmed Immediate Need eligible reported
more than 1 month prior
Unconfirmed Immediate Need eligible reported 1
month prior
Unconfirmed Immediate Need eligible reported in
current month
Forced eligible due to late termination
Partial Month Eligibility (Healthy Families, etc.)
MEDS changed aid code to limited scope due to
DRA Citizenship/Identity requirements not
met
7
8
9
1
2
3
4
5
6
7
8
9
0
1
1359
Not ABAWD
ABAWD
ADDRESS FLAG
0305
пЂ­ Good Deliverable Address
A Address certified via Finalist
* C County Override, not certified via Finalist
D Presumed mailable; Finalist changes unreliable
W BIC mailed - previously A
X BIC mailed - previously C
Y BIC mailed - previously D
пЂ­ Presumed Deliverable Address
Blank Failed Finalist; presumed mailable
0 BIC mailed - previously Blank
Considered Undeliverable Based on Returned Mail
1 BIC returned - previously 0
5 BIC returned - previously W
6 BIC returned - previously X
7 BIC returned - previously Y
9 NOA returned - previously Good Deliverable or
Presumed Deliverable Address
Considered Undeliverable For Other Reasons
2 Failed MEDS validation edits
3 Foster Care Assistance terminated
* 4 Residence address but not a mailable address
* 8 General residence area for a homeless client
* These are the only valid input values (4 and 8 apply
only to a residence address)
Finalist is the MEDS address certification software.
NOTE: Address Flag should only be input when the
Finalist standardized address is incorrect (and needs
to be overridden) (value C) or for a residence address
when it is considered undeliverable (value 4 or 8).
Exception eligible
Forced eligible from MEDS hold
Full Month Eligibility (Healthy Families, etc.)
3rd Digit = Timeliness/Misc. Information
ABAWD
Able-Bodied Adults Without Dependents
0193
Regular eligible reported timely
Regular eligible reported retroactively
3 month retroactive eligible
Continuing eligible reported timely
Continuing eligible reported retroactively
Ramos/Pickle/IHSS/Other Extended eligible
Aid Paid Pending Ramos/Myers
Hold from LTC/SOC status
Ineligible or Regular hold
Revision Date: 9/26/2012
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MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
ALIEN-ELIG-CODE
ALIAS/SSA-NAME-CODE
User Reported Codes
1
2
4
Name reported as Social Security name
Other alias name
Name reported as birth certificate name
MEDS Generated Codes
5
N
T
U
X
Name from CA Birth Record Match
MEDS Name from Verified NUMIDENT SSN
Verification Response
Title II Name from SSN Verification
MEDS Name from Unverified UMIDENT SSN
Verification Response
Title XVI Name from SSN Verification
Old Verification Codes
0
3
8
9
2033
9035
Name and Birthdate validated via the SSA
Referral Process
Name did not match SSA records for SSN
Name and Birthdate validated via a prior
Validation/Referral process
Name and Birthdate validated via the State/SSA
Validation process
* 1
* 2
Refugee admitted under section 207 of the INA
Deportation withheld under section 243(h) or
241(b)(3) of the INA
* 3 Lawful Permanent Residence (LPR) with 40 work
quarters
4 LPR Alien on active duty in the military or an
honorable discharged veteran
5 LPR spouse or unremarried surviving spouse of
active duty military/veteran
6 LPR dependent child of active duty
military/veteran
8 Amerasian admitted to the U.S. as a Lawful
Permanent Resident
9 Aliens who have been battered or subjected to
extreme cruelty and meet the conditions
necessary to be considered a Qualified Alien
W Victim of human trafficking without a visa
application – Non-Citizen Applicant for Trafficking
and Crime Victims Assistance Program who is
taking steps to file for a T Visa or taking steps to
become certified by ORR for federal benefits.
X Victim of domestic violence or other serious
crimes who has filed a U Visa application – NonCitizen Applicant for Trafficking and Crime
Victims
Assistance Program who has filed for a U
Visa.
Y Victim of domestic violence or other serious
crimes – U Visa has been granted.
*
Federal (SDX) input only
Revision Date: 9/26/2012
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MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
APPLICATION-FLAG
3024
BIRTHDATE-VER
County Applications
C Consortia Conversion Transaction-not a new app
D CWD Annual Reevaluation, HF app referral
E CWD Other than annual reevaluation, HF app
referral
F Fair Hearing Exception Referral (Retro Bridging)
G Pending app, general relief benefits, includes
Medi-Cal
N Pending app, No Medi-Cal, No general relief
O Pending app, general relief benefits, No Medi-Cal
P Pending app, Includes Medi-Cal, No general relief
HF/SPE Applications
B Pending app, Includes Medi-Cal and Healthy
Families (HF), from HF/SPE
H Pending app, includes HF, from HF/SPE
R HF Annual Reevaluation, Medi-Cal app referral
S Pending app, includes Medi-Cal, from HF/SPE
T HF Other than annual reevaluation, Medi-Cal app
referral
Z Pending app, No Medi-Cal, No HF, from HF/SPE
Other Applications
A Pending IHSS application
I
IEVS Inquiry only – not a new application
M Pending app, includes Medi-Cal, from MEB
W Pending CHDP Gateway application
APPLICATION-STATUS
3050
Values for reporting status of a pending application
A Incomplete
B No signature
C Failure to provide information
D Pending disability determination
E Misrouted – returned to referring entity
F Fair Hearing
G Diligent Search
P Pending consent
Q Withheld consent
R Referred to another entity
S Received from another entity
T SLP Express Enrollment Eligible
U SLP Express Enrollment Eligibility Not
Determined
V SLP Express Enrollment Ineligible
MEDS Generated Values (not valid for input)
1 Approved
2 Denied
3 Erroneously reported application
M Missing required information to refer
N Not eligible for referral
C
G
R
S
V
Client Reported
Guess (i.e. comatose, abandoned baby)
Within Range on SSN Verification
Verified per Reporting System
Verified per exact NUMIDENT match
BIRTHDATE-VER-SOURCE
N
T
X
W
0128
0127
NUMIDENT SSN Verification
Title II SSN Verification
Title XVI SSN Verification
Worker Reported
BUY-IN-ELIG-CD
0832
A
B
C
D
E
aged recipient of Federal SSI payments
blind recipient of Federal SSI payments
entitled to Part A of Title IV (AFDC)
disabled recipient of Federal SSI payments
aged recipient of supplemental payment
administered by SSA
F blind recipient of supplemental payment
administered by SSA
G disabled recipient of supplemental payment
administered by SSA
H aged, blind, or disabled recipient of a one time
payment
L Specified Low Income Medicare Beneficiary
(SLMB)
M entitled to Medical Assistance Only (MAO) –
(non-cash recipients who are not QMBs)
N none (default value)
P Qualified Medicare Beneficiary (QMB)
U Qualifying Individual 1 (QI-1)
Z deemed categorically needy
CLIENT DATA RECON CHANGE SOURCE
See QD screen under CLIENT-CHG-SOURCE
A
E
F
G
H
M
O
P
R
S
X
Application
County, Other than Food Stamps
County, Food Stamps
CCS/GHPP
Healthy Families
Medi-Cal Eligibility Branch
Other DHS Entity
Provider reported Gateway eligibility
Reconciliation update
Single Point of Entry
SDX
Revision Date: 9/26/2012
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CITIZEN /ALIEN IND
A
B
C
D
E
* F
* G
* H
K
L
* M
* N
O
*P
* Q
R
S
T
U
V
W
X
Y
Z
*** 0
*** 1
5
*** 7
8
*** 9
DEATH-CD (Source of Death Information)
2009
Proven U.S. citizen
Alleged U.S. citizen
Conditional entrant admitted under INA section
203(a)(7)
Deportation withheld admitted under INA section
243(h) or 241(b)(3)
Amerasian refugee admitted under INA sec 207
Refugee admitted under INA sec 207 or 203(a)(7)
Parolee admitted under INA section 212(d)(5)
Silva vs. Levi alien
Lawful permanent resident (LPR)
Asylee admitted under INA section 208 but not
Kurdish or Iraqi asylee
Residents of the Northern Mariana Islands
Identity and citizenship of the individual verified
by the Numident interface (code was previously A
or B)
Victim of Severe Forms of Trafficking who have
been certified by ORR or who has been granted a
T Visa
Pre-Jan 1, 1972 alien (presumed lawfully
admitted for permanent residence)
Alleged born in U.S., corroborated by a U.S.
birthplace shown on online Numident
Other refugee admitted under INA section 207
but not Amerasian or Indochinese refugee
Other aliens (not a temporary visa holder)
Alleged PRUCOL
Undocumented alien
Visitor / Student / VISA and other aliens with
temporary documentation
Parolee admitted under INA section 212(d)(5)
with a period of parole over one year
Indochinese refugee admitted under INA sec 207
Parolee admitted under INA section 212(d)(5)
with a period of parole less than one year
Kurdish or Iraqi asylee admitted under INA
section 208
Other alien (not 1, 5, 7, 8, or 9)
Indochinese refugee admitted under INA sec 207
Citizen child born to refugee parent(s)
Other refugee
Cuban/Haitian entrant
Aged alien (Medicare ineligible alien and
not 1, 7, or 8)
B
C
D
E
F
G
H
I
J
K
L
M
O
P
R
S
T
U
V
W
X
Y
File
Z
2019
Medicare Buy-In System Reported Death
Termination Reason
County Welfare Department Worker Reported
Death Date
SSN Verification – Vital Records Electronic Death
Notice Per Title XVI
SSN Verification – Death Date from NUMIDENT
File
BENDEX Reported Death Date
SSN Verification – SSA District Office Reported
Death Date Per Title XVI
SSN Verification – State Reported Death Date
Per Title XVI
SSN Verification – Title II Reported Death Date
Per Title XVI
SSN Verification – Title II Reported Death Date
Per Title II
Medicare Buy-In System Reported Death Date
Deceased per Claim Record (Not Currently
Reported in MEDS)
MCED Reported Death Date
Other State/County Worker Reported Death Date
Pickle Update Reported Death Termination
Reason
Returned Mail Marked Deceased
SDX Reported Title XVI Death Date
County Reported Death Termination Reason
MCED Altered Vital Records Reported Death
Date
CA Vital Records Reported Death Date
SSN Verification – Returned Check Reported
Death Month/Year Per Title XVI
SSN Verification – Returned Check Reported
Deceased Per Title XVI
SSN Verification – Deceased Per NUMIDENT
But No Death Date Provided
BENDEX Reported Death Termination Reason
* Federal (SDX) input only
*** Values obsolete 12/98
Revision Date: 9/26/2012
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DENIAL-REAS (Denial Reason)
3029
A
B
C
D
E
F
**
**
*
Client Deceased
Application Withdrawn
Moved Out of State
Loss of Contact/Unable to Locate Applicant
Failure to Cooperate
Does Not Meet California Residency
Requirements
G Excess Resources
H No Program Linkage
I
Potential State Only Program Eligible did not
apply for ongoing Medi-Cal
J No Deprivation
K Living in a Public Non-Medical Institution
L Existing AFDC/Medi-Cal/CMSP Recipient
M Existing SSI/SSP Recipient
N Receiving Medicaid in Another State
P Duplicate Pending Application
Q IE/RR terminates accelerated enrollment (MEDS
Generated)
R Other
S Applicant can’t apply for the person on the
application
Y Erroneously Reported Application
Z No Valid Data Reported (MEDS Generated)
1 Premium Not Paid
2 Income Does Not Meet Requirements
3 Home Address State Missing or Invalid
4 End Date for Employer Sponsored Insurance
Missing or Invalid
5 Child is Eligible for Medicare Part A and B
6 Funding Not Available
7 Child age 19 or over not eligible for HFP
*
**
Values applicable only to MEB applications
Values applicable only to Healthy Family applications
*
**
**
**
**
ESAC (Eligibility Status Action Code)
9109
1
2
3
4
Continuing Eligibility Periods
New Eligible
Active Client Eligible Update
Linked Program Eligible – Declined Medi-Cal
Exception Eligible
6
7
8
9
Closed Eligibility Periods
New Eligible
Active Client Eligible Update
Linked Program Eligible – Declined Medi-Cal
Exception Eligible
Other Eligibility Updates
0 (ZERO) County Confirmed Immediate Need
SSI/SSP Eligible
A Unborn
B Hold, questionable eligibility
Recon Generated Hold on MEDS
Recon Hold – On MEDS, Not on County
Recon Hold – Key field discrepancy in County-ID
or Birthdate
M Recon Hold – Critical eligibility errors on county
transaction
N Recon Hold – Duplicate county records received
K
L
F
P
Q
R
Legacy System Only
QMB pending part A confirmation (obsolete – will
be treated by MEDS like ESAC 1)
Pending application
Drop pending change
Release hold
ETHNIC
1
2
3
4
5
7
8
9
A
C
H
J
K
M
N
P
R
T
V
Z
White
Hispanic
Black
Asian or Pacific Islander
Alaskan Native or American Indian
Filipino
No Valid Data Reported (MEDS generated)
No response, client declined to state
Amerasian
Chinese
Cambodian
Japanese
Korean
Samoan
Asian Indian
Hawaiian
Guamanian
Laotian
Vietnamese
Other
Revision Date: 9/26/2012
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0115
MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
0125
GOVT-RESP
Identifies the entity that has primary responsibility for
current and/or history eligibility.
1
2
3
6
9
County Welfare Department (CWD) or MEB
controlled eligibility, other than Food Stamps
Federal or State controlled Federal continuing
Terminated Federal record
Other than 1, 2, 3 or 9 –
May have Food Stamps, IE/RR, CCS, GHPP,
and/or Healthy Families
Frozen Record
HCPn-STAT
(HCP Status)
1019
00 Voluntary disenrollment - No capitation paid
01 Active enrollment - Capitation paid
05 HCP hold due to recipient Medi-Cal ineligibility No capitation paid
09 Mandatory disenrollment - No capitation paid
10 Voluntary disenrollment - Capitation recovery
required
19 Mandatory disenrollment - Capitation recovery
required
40 Voluntary disenrollment occurred before
enrollment became effective
49 Mandatory disenrollment occurred before
enrollment became effective
51 Enrollment activated from HCP hold or unmet
SOC - Supplemental capitation to be paid at end
of month
55 Potential plan member - unmet SOC
59 HCP hold due to HCP coverage limits - No
capitation paid (see HCP Reason)
HCPn-REAS
(HCP Reason)
1004
Reason for HCP hold status �59’
A
C
H
Z
Aid code not covered
County not covered
OHC exclusion
ZIP Code not covered
HCPn-TYPE
C
D
H
M
O
COHS (County Organized Health System)
Dental
HMO (Health Maintenance Organization)
Medical (future use)
Other
HEALTH INSURANCE SYSTEM:
Scope of Coverage
COVERAGE CODE
D
I
L
M
O
P
R
V
SERVICE
Dental
Hospital Inpatient
Long Term Care
Medical and Allied Services
Hospital Outpatient
Prescription Drugs
Medicare Part D
Vision Care
If coverage unknown, OHC is regarded as comprehensive Provider must bill OHC carrier for all services.
Order on HIS is as follows: O I M P L D V R
P4 Pending enrollment - Application accepted
S0 Voluntary disenrollment - Capitation recovery
processed
S1 Active enrollment - Supplemental capitation paid
S9 Mandatory disenrollment - Capitation recovery
processed
SPECIAL CONSIDERATION FOR HCP STATUS:
�51’ is updated to �S1’ when RENEWAL initiates
payment of capitation.
�10’ and �19’ are updated to �S0’ and �S9’ after
RENEWAL initiates recovery of capitation.
MEDS RENEWAL terminates an HCP enrollment
effective current month after two consecutive months
of HCP hold.
Revision Date: 9/26/2012
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LANGUAGE
* 0
1
2
3
4
5
6
7
8
9
* A
B
C
D
E
F
G
H
I
J
K
L
M
N
P
Q
R
S
T
U
V
(Spoken Language)
(Written Language)
0120
0121
American Sign Language (ASL)
Spanish
Cantonese
Japanese
Korean
Tagalog
Other Non-English
English
No Valid Data Reported (MEDS generated)
No response, client declined to state
Other Sign Language
Mandarin
Other Chinese Languages
Cambodian
Armenian
Ilocano
Mien
Hmong
Lao
Turkish
Hebrew
French
Polish
Russian
Portuguese
Italian
Arabic
Samoan
Thai
Farsi
Vietnamese
MEDICARE
1st Digit = Part A (Hospital)
2nd Digit = Part B (Medical)
3rd Digit = Part D (Prescription Drug)
1st and 2nd Digits
0 or Blank No coverage
1 Paid for by beneficiary
2 Paid for by State Buy-In
3 Free (Part A only)
4 Paid by state other than California
5 Paid for by Pension Fund
7 Presumed eligible
9 Aged alien ineligible for Medicare
3rd Digit
4869
0 or Blank No Coverage
1 Approved Low Income Subsidy Status
2 Beneficiary is eligible for Part D
3 Beneficiary deemed Low Income Subsidy eligible
7 Presumed eligible
9 Beneficiary has refused Part D
Note: Medicare Status Values “6” and “8” (for Parts A
& B) are no longer valid values. Medicare Status Value
“7” will no longer be assigned as of 09/26/2006.
NOA-LANGUAGE-SOURCE
NOA-LANGUAGE-TYPE
1
2
C
G
R
4028
W MEDS Written Language
S MEDS Spoken Language
* Not valid values for 0121 Written Language
MEDICAID ELIGIBILITY CODE
4849
0698
Confers 1619B eligibility - free Medicaid
Goldberg-Kelly eligibility - timely appeal with SSA
confers both SSI/SSP payment and free Medicaid
Referred to county
English-Only NOA mailed to the recipient
English plus 11 languages (booklet) mailed to the
recipient
NOA-STATUS (Notice of Action Status)
1
2
3
4
4026
Mailed
Undeliverable (Bad Address on MEDS)
Returned
Re-mailed
Revision Date: 9/26/2012
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NOA-TYPE (Notice of Action Type)
01
02
03
04
05
06
07
08
09
10
11
12
17
18
19
22
23
26
27
28
29
51
60
2049
4025
Excess Income
Persons in Long-Term Care
Extended Medi-Cal Eligibility
Loss of Residence
Deceased
Loss of Contact
Other
Deceased Persons – Returned Card
County Eligible
Extended Medi-Cal Eligibility: Disabled Adult
Child
Deceased Persons – State Registrar
Disabled Widow(er)s
Disabled Medi-Cal, Later Not Found Disabled by
SSA
Qualifying Individual – 1 (QI-1)
Qualifying Individual – 2 (QI-2)
Non-Grandfathered NLD/Blind (second notice)
All NLD/Blind (final notice)
All NLD/Blind (first notice)
Grandfathered NLD/Blind (second notice)
All NLD/Blind rescission of county termination
Grandfathered NLD/Blind (one-time)
Extended Medi-Cal Eligibility: 503 Leads – Pickle
MMA Reduction of Benefits
Note: NLD/Blind = No Longer Disabled/Blind
OHC
A
C
D
G
F
I
K
L
P
V
9
N
O
1109
Pay and Chase OHC / Post Payment Recovery
Any carrier (includes multiple coverage)
Cost Avoidance OHC
Champus Prime HMO
Medicare Part D
Medical Parole
Medicare RISK HMO
Institutionalization (Public Institution coverage)
Kaiser
Dental only policies
PHP/HMO’s & EPO (Exclusive Provider Option)
not otherwise specified
Any carrier (other than the above, includes
multiple coverage)
Healthy Families
Other OHC Related Codes
None
Override - Used to remove cost avoidance OHC
codes posted by DHS Recovery (OHC-Source of
H, R, or T) --- changes OHC to A
OHC-SOURCE
1129
A
Update from SPE Accelerated Enrollment (AE)
or AIM Program
C or Blank County Welfare Department (CWD)
F Healthy Families (HF) Administrative Vendor
G CMS-Net/GHPP System
H Update from Other Health Coverage Recovery
I
County reported Institutionalization
J County reported release from Institutionalization
M MEDS assigned from the OHC update logic
O CHDP Gateway Override
P Provider Initiated AE
R Batch update from the OHC Master file
S Update from SSI/MEB
T Insurance information exchange with carrier
U Unknown (indicates problem in MEDS OHC logic)
X OHC �9’ changed to �A’ based on Foster Care
eligibility
PAYMENT STATUS CODE
0625
Common SSI/SSP Payment Status Codes
See QX screen under Payment Status
C01
Current pay
E01
Eligible but no payment due (many times
these are in LTC)
N01
Nonpay recipient's countable income
exceeds Title XVI payment amount and
his/her state's payment standard
N02
Nonpay recipient is inmate of public
institution
N03
Nonpay recipient is outside USA
N04
Nonpay recipient's non-excludable
resources exceed Title XVI limitations
N07
No longer disabled
N10
Failure to comply with approved
drug or alcohol treatment plan
N11
Benefit sanction month because of failure to
comply with approved treatment plan
N13
Not a citizen or is an ineligible alien
N22
Inmate of a penal institution
N23
Not a resident of the USA
N24
Claimant has been convicted of a felony of
fraudulently misrepresenting residence
N25
Claimant is a fugitive felon or
parole/probation violator
S06
Suspended - Recipient's address unknown
S08
Suspended - Representative payee
development pending
T01
Terminated - Death of recipient
T30
Terminated (manual termination)
sort of an "other" category
T31
Terminated (system generated termination)
sort of an "other" category
T33
Terminated (manual termination)
Revision Date: 9/26/2012
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MEDS NETWORK USER MANUAL
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No previous payment made (will eventually
Replace T30)
PICKLE STATUS
2032
PICKLE
Identifies Special SSI/SSP Client Status
Second digit on QM screen Pickle
0
No update received (MEDS generated)
(Only records coded with 'C0' are included on 503 Leads
Report. When a county reports LTC aid codes or term
reasons 01 (death) or 98 (whereabouts unknown), the 'C0'
stays on MEDS but the record goes off the 503 Leads
Report.)
1
Potential Pickle eligible (also posted by MEDS if
Pickle aid code reported)
(Used with EW60 to remove a Potential Pickle from 503 Leads
and onto Pickle Tickler. Can change C2's and C3's back to
C1.)
2
Recipient requested not to be contacted
1st byte - see Pickle Type
PICKLE TYPE
A
C
M
P
T
Loss of contact/whereabouts unknown
(Used to remove Potential Pickle from 503 Leads and onto
Pickle Tickler.)
4
5
7
8
9
Grandfathered No Longer Disabled (NLD) child
Non-Grandfathered No Longer Disabled (NLD)
adult or child
Remove erroneously reported Potential Pickle
(Pickle Type A, M or P)
Immediate Need SSI/SSP card issued pending
SSA eligibility confirmation (MEDS generated)
Deceased
(Places Death Source of P and Death Date which is filled in
with the date the death was posted, doesn’t change Pickle
Status)
L
Terminated SSI/SSP recipient in Long Term Care
NOTES:
п‚· PICKLE STATUS 4 and 5 are associated only with
PICKLE TYPE D.
п‚· PICKLE TYPE S, R, Q, and V will only show PICKLE
STATUS 0.
пЃќ 503 Leads - Includes persons who are
terminated from SSI/SSP at the end of December
due to the Title II COLA
2031
First digit on QM screen Pickle
(Used to remove Potential Pickle from 503 Leads and onto
Pickle Tickler.)
3
2nd byte - see Pickle Status
Potential Pickle Eligibles
Potential Pickle based on aid code
COLA terminated SSI/SSP eligible
Potential Pickle moved into state
Potential Pickle identified by county
Terminated SSI/SSP recipient also receiving
Title II benefits
S
R
Q
V
SSP Reduction Eligibles
5.8% beneficiaries 1992
2.7% beneficiaries 1993
2.3% beneficiaries 1994
4.9% beneficiaries 1995
D
No Longer Disabled (NLD) Eligibles
No Longer Disabled (NLD) adult or child
Exception Eligibles
Terminated IHSS recipient
Terminated SSI/SSP recipient – Disabled Adult
Child
W Terminated SSI/SSP recipient – Disabled
Widow(er)s
X Terminated SSI/SSP recipient
I
T
Note: M and P are county reported, all other types
are MEDS generated. A, M and P are removable
(can be changed by the county).
пЃќ Pickle Tickler - Persons who must be tracked
for future Pickle eligibility
Revision Date: 9/26/2012
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REASON-FOR-ISSUANCE
9055
01 Initial card for new eligible or Immediate Need
eligible
02 BIC not received
BIC Replacement
21 Lost, Stolen, Mutilated, or Incorrect Card
RECV-REF
Received From / Referred To Entity
CO
CP
FS
HF
IN
MB
OP
SL
3049
County Welfare Department
Other County Medical programs
Food Stamps
Healthy Families
Individual
Medi-Cal Eligibility Branch, State of California
Other program not specifically identified
School Lunch Program
RECOVERY
(a.k.a. Overpayment Recovery Indicator)
Blank No overpayment
1 CalWORKs overpayment
2 Food Stamp overpayment
3 CalWORKs and Food Stamp overpayment
(system generated)
2020
REL-TO-APP
Relationship to Applicant
1
2
3
4
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Applicant’s child
Adult 2’s child
Significant other
Ex-step parent
Aunt/Uncle
Step Child
Child, common
Son/Daughter-in-law
Brother/Sister-in-law
Foster Child
Grandparent
Dependent of a minor dependent
Mother/Father-in-law
Brother/Sister
Grandchild
Legal Guardianship
Adoptive Child
Niece/Nephew
Other
Parent
Cousin
Collateral dependent
Spouse
Stepfather
Unborn
Stepmother
Ward
Ex-spouse
Yourself (i.e., Applicant)
Unknown
RESIDENCE ADDRESS FLAG
Y
N
3053
0303
Reported as a residence address
Mailing address, may or may not be a residence
address
RESIDENCE COUNTY
0176
пЃ¶ Identifies the county in which the client resides.
пЃ¶ Set when a residence address is reported and Finalist
identifies a residence county OR when a county
reports the residence county because it is different
from the responsible county.
пЃ¶ Used for HCP enrollment decisions.
пЃ¶ See county code list for values (01 - 58); out of state
residences will show �99’ for the residence county.
Revision Date: 9/26/2012
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RESTRICT
1229/9129
1st and 2nd digits = Restricted Service Status
3rd digit of �1’ = County Limited Inquiry Access
1st and 2nd digits of �0’ with 3rd digit greater than �1’ = Minor
Consent
000
001
Restriction or Limited Inquiry access
removed
County confidential case - Limited inquiry
access
Minor Consent Services related to:
(assigned by aid code)
004
no longer in use
005 (aid 7P)
Sexually Transmitted Diseases,
Sexual Assault, Drug and Alcohol
Abuse, Family Planning, and
Outpatient Mental Health
006 (aid 7R)
Sexual Assault and Family Planning
007 (aid 7M)
Sexually Transmitted Diseases,
Sexual Assault, Drug and Alcohol
Abuse, and Family Planning
008 (aid 7N)
Pregnancy and Family Planning
Service Restrictions
010/011 Prior authorization required for drugs
050/051 Prior authorization required for scheduled drugs
110/111 Prior authorization required for M.D.
visits
120/121 Prior authorization required for M.D.
visits and drugs
140/141 Prior authorization required for all
services, except emergencies
150/151 Restricted to primary M.D. and prior
authorization required for drugs
200/201 Prior authorization required for Dental
visits
210/211 Prior authorization required for Dental
visits and drugs
220/221 Prior authorization required for Physician
visits and Dental visits
230/231 Prior authorization required for Physician
visits, Dental visits, and drugs
240/241 Recipient is restricted to primary
Physician with prior authorization
required for drugs and Dental visits
600/601 For claims payment, BIC Id number and
issue date required
900/901 Hospice services only
910/911 Hospice services overlaid previous
S/URS restriction
920/921 Hospice services posted retroactively
930/931 Hospice services retroactively overlaid
previous S/URS restriction
950/951 Long Term Care (LTC) restriction due to
transfer of assets
960/961 Long Term Care restriction overlaid
previous S/URS restriction
970/971 Medi-Cal ineligible due to non-
cooperation in medical support
enforcement
980/981 Medi-Cal ineligible due to noncooperation in medical support
enforcement overlaid previous S/URS
restriction
RETRO (was PRE/POST CD)
0
1
2
3
4
5
6
7
9169
Three Month Retroactive Eligibility
Retroactive month(s)
1st month prior
2nd month prior
3rd month prior
1st and 2nd months prior
1st and 3rd months prior
2nd and 3rd months prior
1st, 2nd and 3rd months prior
Numbers 1 through 7 identify which month(s) prior
to the application date have the same eligibility as the
effective month.
SEX
F
M
U
N
(Gender)
0110
Female
Male
Unborn
Not known - Federal (SDX) input only – SDX
record had sex code of �U’ meaning Unknown
Revision Date: 9/26/2012
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Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
M Verification request pending for SSN reported
as not sight verified
SSN-VER
0106
N
Valid User Input
0
1
2
3
5
6
8
9
R
Used on certain input transactions to
indicate that the SSN Verification status was
previously reported to MEDS
SSN reported by client,
not sight verified/no SSA referral initiated
SSN application filed at SSA district office,
confirmation received by reporting entity
SSN reported by client, sight verified by
reporting entity
SSN reported by client, not sight verified, SSA
referral initiated
Client does not have an SSN, SSA referral
initiated
Client does not have an SSN and cannot get
one - undocumented person
SSN not reported by client
Used on certain input transactions to indicate that
the SSN Verification Code needs to be removed
MEDS Generated
7
A
B
C
D
E
F
H
I
J
SSA
K
L
No valid SSN verification status reported by
entity reporting the SSN to MEDS
SSN verified via SSA NUMIDENT data
match – SSA birthdate exactly matches MEDS
SSN verified via SSA NUMIDENT data
match – SSA birthdate exactly matches MEDS/
Surname did not match
SSN verified via SSA NUMIDENT data
match – SSA birthdate does not exactly match
MEDS
SSN verified via SSA NUMIDENT data
match – SSA birthdate does not exactly match
MEDS/Surname did not match
SSN verified via SSA NUMIDENT data
match – SSA birthdate not available for exact
MEDS match check
SSN verified via SSA NUMIDENT data
match – SSA birthdate not available for exact
MEDS match check/Surname did not match
SSN verified via Title II and Title XVI data match
- failed SSA NUMIDENT data match
SSN verified via Title II data match - failed SSA
NUMIDENT data match
SSN verified via Title XVI data match - failed
NUMIDENT data match
SSN verified via Title II and Title XVI data match
- SSN not recognized as an SSN issued by SSA
In NUMIDENT data match
Verification request pending for SSN reported
as sight verified
SSN verification failed SSA NUMIDENT data
match on birthdate
O SSN verification failed SSA NUMIDENT data
match on birthdate and failed Title XVI data
match
P SSN verification failed SSA NUMIDENT data
match on birthdate and failed Title II data
match
Q SSN verification failed SSA NUMIDENT data
match on birthdate and failed Title XVI and Title II
data match
S SSN verification failed SSA NUMIDENT data
match on surname or given name
T SSN verification failed SSA NUMIDENT data
match on surname or given name and failed Title
XVI data match
U SSN verification failed SSA NUMIDENT data
match on surname or given name and failed Title
II data match
V SSN verification failed SSA NUMIDENT data
match on surname or given name and failed Title
XVI and Title II data match
W SSN identified as verified via prior SSN
verification process
X SSN identified as verified via prior SSN
verification process, but SSN verification
subsequently removed
Y SSN identified as unverified via prior SSN
verification process
% SSN verification failed SSA NUMIDENT
data match – probable transcription error
identified
& SSN verification failed SSA NUMIDENT
data match – SSN not recognized as an SSN
issued by SSA
* SSN identified as verified via SVES SSN
verification process but SSN verification code
subsequently removed by worker
# SSN identified as verified via SVES SSN
verification process but SSN verification code
subsequently removed by SSI/SSP update
!
SSN failed SSA NUMIDENT data match; given
name missing
Revision Date: 9/26/2012
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MEDS NETWORK USER MANUAL
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52
53
TERM REAS
0185
Note: #
Indicates acceptable Edwards Term Reason
(will terminate/prevent establishment of
Edwards)
NOTE: The only Term Reasons requested to be
consistently used by all counties are those preceded
by a # or *.
County reported Term Reasons
# 01
# 03
# 04
05
06
07
08
09
17
18
19
# 20
21
22
23
24
27
28
29
32
33
34
# 35
36
37
# 38
39
40
# 44
45
46
47
# 48
49
50
Discontinuance due to death
Discontinuance at recipient request
(MC only, CalWORKs/MC)
Failure to cooperate (MC only)
Increased earnings of father
Increased earnings of mother
Increased earnings of child
Increased earnings of stepfather
Other increased earnings in home
Increased support - absent parent return
Increased support - remarriage of parent
Increased support - absent father
Term Medi-Cal (allegation of disability)
Increased support - other outside source
Increased income from OASDI
Increased income from other Federal
program
Increased income from Veterans benefits
Increased income - Unemployment/Disability
Insurance
Increased income - other state/local
program
Increased income - non-government
program
Increased income from any other source
Increase in real property
Increase in personal property
CalWORKs Term, MEDS eligibility reported
under another MEDS-ID by county agency
(i.e. Foster Care)
"Need" change: law or policy determination
Decrease in "need"
Determined ineligible for Medi-Cal only
Financial reason not codes 36 or 37
Parent no longer incapacitated
Resident of a public institution
Parent returned home or remarried
Change in law or agency policy
No longer eligible child in home
Loss of legal residence
No Program Linkage-other than 38 and 40-48
Refused to comply - property utilities
requirement
54
55
56
# 57
58
59
60
61
* 64
* 65
70
* 83
# 89
93
94
95
96
97
98
99
Refused to participate in GAIN program
Refused to seek work in program other than
GAIN
Refused to accept work - EDD referral
Refused to accept work - other referral
Refused training/education (not GAIN)
CalWORKs recipient has been transferred
into the SSI program
CalWORKs recipient has transferred into
another county-administered program
Other than 50-70
Refused to provide CA7 or Medi-Cal status
report
Refused to provide essential information
(non-CA7)
Failed to complete Medi-Cal Midyear Status
Review
Failed to complete Medi-Cal Annual RV
Refused to register with EDD
CalWORKs - timed-out adult and family
income ineligible
Whereabouts unknown – Medi-Cal
CalWORKs - transferred to FG from U
CalWORKs - transferred to U from FG
CalWORKs - transferred to FC from FG or U
Transferred to another county
Discontinued at recipient request
Whereabouts unknown-other than Medi-Cal
Other than 01-98 above
Healthy Families reported Term Reasons
H1
H2
H3
H4
H5
H6
H7
H8
H9
HA
HB
HC
HD
HE
HF
HG
HH
HJ
HK
60 day retro HF disenrollment
Program generated HF disenrollment
Client requested HF disenrollment
Erroneous enrollment
Client shows Medi-Cal / Medicare
Deceased
Decrease in Income, no longer qualifies
False declarations
Requalification information not provided
Annual eligibility review (AER) determined
increase in income, no longer qualifies
Annual eligibility review determined client
covered under other health insurance
Proof of citizenship
Child link program requirements not met other
Child link program requirements not met due
to child HF disenrollment
Client shows Medi-Cal / Medicare at AER
AER Requalification information not provided
Decrease in Income, no longer qualifies at
AER
Client requested HF disenrollment at AER
Disenrollment due to non-payment of
premium
Revision Date: 9/26/2012
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Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
HL
Client terminated as a result of Healthy
Families Reconciliation
TERM-REAS continued on next page
TERM REAS
(continued)
0185
MEB reported Term Reasons
MB
MC
State only Breast Cancer (time-limited)
State only Cervical Cancer (time-limited)
SS/S
TT
VV
WW
X1
X2
ZZ
MEDS Generated Term Reasons
Z1
# AA
A1
A2
A3
A4
A5
A6
CC
C1
D1
D2
D3
D4
D5
D6
D7
D8
D9
EE
FF
IN
MA
M1
M2
M3
OB
OS
PP
# RR
RT
SR
Out of State Foster Care (per zip code)
Application determined – IE/RR eligibility
reported
Application determined – Other Medi-Cal
eligibility or IH/PCS eligibility reported
Application determined – Healthy Families
eligibility reported
Application determined – Medi-Cal denial
reported
Application determined – Healthy Families
denial reported
Application Determined – Healthy Families
Gateway terminated on Medi-Cal denial
because no Healthy Families referral
CMSP companion without corresponding
primary eligibility
Death removed via EW03
Death reported via returned card
Death reported by MEB
Death reported by Vital Statistics
Death reported by SDX
Death reported by CWD
Death reported on Buy-In update
Death reported by Healthy Families
Death reported on SSN Verification
Death reported on BENDEX update
Exception eligibles
Terminated by state via a File Fix
Eligibility reported via Immediate Need trans
Accelerated BCCTP (time-limited)
Terminated by MEB
Death removed by MEB, no eligibility
Gateway initial enrollment period OA
Residence outside of California
Moved out of state per Buy-In/BENDEX
Moved out of state per SDX
Pregnancy/FPL/Percentage program expired
On MEDS Not County – Recon termination
Recon Data Discrepancy – Closed period
ESAC on Legacy trans – Recon Term
Date/Reason used
Exceeds 8 month RMA/EMA or RCA/ECA
eligibility
Renewal terminated after 2 months hold
CMSP aid code/non-CMSP county
Pickle presumptive termination
Renewal terminated current aid code
invalid
Cessation of Disability - NOA type 23
Cessation of Disability - NOA type CO
Terminated by MEDS – transitional exceeded
maximum months
MEDS established time-limited eligibility
MEDS Generated Hold Reasons
B
J
K
L
M
N
Hold, questionable eligibility
MEDS Hold due to rejected eligibility status
update in the daily batch process
Recon Hold – On MEDS, not on County
Recon Hold – Key field discrepancy in
County-ID or Birthdate
Recon Hold – Critical eligibility errors on
county transaction
Recon Hold – Duplicate county records
received
WELFARE-PGM *
(a.k.a. Global Program Indicator)
0195
MEDS current or history Welfare program(s) recipient
eligible for:
001
003
004
005
007
Health Program without CalWORKs cash grant
Health Program and CalWORKs cash grant
Food Stamps only
Health Program and Food Stamps
Health Program, CalWORKs cash grant and
Food Stamps
NOTE: Health Program may include Medi-Cal,
CMSP, Healthy Families, CCS, GHPP, BCCTP,
etc.
Revision Date: 9/26/2012
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Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
MEDS TRANSACTION CODES
пЂє
SS10
SS30
SU30
Indicates a Function key is available for the transaction code
State and Federal and Other Transactions
BE30
BINQ
BI30
BI31
BI35
BI37
BI60
BI65
BR30
DP30
GZ10
GZ11
GZ12
GZ20
HF10
HF11
HF12
HF18
HF20
HF30
HF34
HF40
IH05
IH12
IH18
IH20
IH34
IH40
MB10
MB11
MB12
MB13
MB30
MB55
MW18
MW19
MW20
MW32
MW34
MW40
OC30
PE15
PE18
PE20
PH30
PH40
RB30
RB31
SD10
SD20
SD21
SP20
Bendex Update
Buy-In Update Request
Buy-In Update Part B
Buy-In Update closed period
Buy-In Update Part A
Buy-In Update Medicare Status Code
Buy-In Exception Deletion Part B
Part A Accretion/Deletion
BRU SOC Certification for Individual
Returned Card/Deceased
MEDS-ID Number Change (CCS/GHPP)
MEDS Record Consolidation (CCS/GHPP)
Update Client Information (CCS/GHPP)
Add New CCS/GHPP Client
MEDS-ID Number Change (HF only recipient)
MEDS Record Consolidation (HF recipient)
Modify Client Information
Report New HF Application
Add New Client HF Eligibility
Modify/Terminate HF Eligibility
Modify Existing HF Application
HF Termination
Transfer County of Responsibility
Update Client Information
Report New Application
Add New Client Record
Modify Application/Appeal Information
IHSS/PCSP Termination
MEDS-ID Number Change (MEB)
MEDS Record Consolidation (MEB)
Modify Client Information (MEB)
Update NOA Information
MEB Update
SSI/SSP Modify/ID Card Request
Pending Application (MEB)
Citizenship status/identity verification (MEB)
Add New Client Eligibility (MEB)
Medical Parole Client Update (MEB)
Modify Application/Appeal Information (MEB)
Termination (MEB)
Modify OHC/ID Card Request (Health
Insurance Section)
Report Immediate Need Accelerated
Enrollment (AE) (Provider)
Report New Application (Provider)
Add New Client AE Eligibility (Provider)
Modify HCP Enrollment Record
HCP Disenrollment
Returned BIC
Returned BIC/Deceased
SDX Recipient MEDS-ID Number Change
SDX Recipient Add/Update
Extended Eligibility
Report HF Accelerated Enrollment
SSN Referral Update
SSN Validation Update
S/URS Status Change (Service Restrictions,
i.e. hospice, restricted doctor visits, etc.)
Health Insurance Database Transactions
These transactions update the Health Insurance System (HIS) database
HI05
HI10
HI30
HI35
HI37
HI38
HI39
HI40
HI60
HI61
Chaining Update (MEDS generated)
MEDS-ID Change (MEDS generated)
OHC Code Change (MEDS generated)
Add/Modify Health Insurance Information
Add/Modify Health Insurance Information
from batch sources (SSA, LEADER, ISAWS)
Add/Modify Healthy Families HIS Information
Add/Modify CCS/GHPP HIS Information
Casualty & Workers’ Compensation Referrals
Add/Modify Carrier File Information
Add/Modify Carrier File Follow-Up Information
County Transactions
пЂє
пЂє
пЂє
пЂє
пЂє
пЂє
пЂє
пЂє
пЂє
AP18
AP20
AP22
AP34
EW03
EW05
EW10
EW11
EW12
EW15
EW20
EW25
EW30
EW31
EW32
EW34
пЂє EW35
пЂє EW40
пЂє EW45
EW50
пЂє EW55
EW60
FR20
FX05
FX10
пЂє FX20
пЂє FX30
Report New Application
Report New Application (IEVS or batch)
Save Inquiry (IEVS or batch)
Modify Application/Appeal Information
Exception Correction Update
Transfer County of Responsibility [F1]
MEDS-ID Number Change [F2]
MEDS Record Consolidation [F14]
Update Client Information [F10]
Report Immediate Need Eligibility [F3]
Add New Client Record [F4]
Modify - Whole Case [F5]
Modify Current/Future (Individual) [F6]
Modify History/Miscellaneous (Individual)
[F18]
Institutionalized Client Update
Modify Application/Appeal Information (now
AP34)
Termination or Hold - Whole Case [F7]
Termination/Hold Status Change (Individual)
[F8]
Request Replacement ID Card [F9]
Eligibility Over 12 Months Prior
SSI/SSP Modify/ID Card Request [F15]
Modify Pickle Status Information
Reconcile Food Stamp (batch only)
Transfer County of Responsibility (batch only)
MEDS-ID Number Change (Food Stamp
Only Recipient)
Add New Food Stamp Recipient Record [F16]
Modify Food Stamp Record (Individual) [F17]
County Transactions continued on next page
County Transactions (continued)
Revision Date: 9/26/2012
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Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
FX31
Modify Food Stamp Record (allows for
ABAWD indicator removal)
County Transactions continued on next page
FX40 Food Stamp Termination (batch only)
FX60 ABAWD Food Stamp 36-Month Calendar
HA20 Report New Homeless Client (HOME or
batch)
RC20 Reconcile Non-Food Stamp (batch only)
MEDS Generated Reconciliation Trans
FR12
FR20
FR25
FR40
Update Client Information – Food Stamp
Add Food Stamp Eligibility
Update Case Information – Food Stamp
Terminate Food Stamp Eligibility
Inquiry Transactions
F13 is a �HELP’ key in many of these applications
HEMI
HOLD
IAPP
пЂє INQN
пЂє INQR
пЂє INQW
пЂє INWA
пЂє INXR
MR20 Extract MEDS/CDB Record
RC12
RC20
RC25
RC40
Update Client Information – Non-Food Stamp
Add/Modify Non-Food Stamp Eligibility
Update Case Information – Non-Food Stamp
Hold/Terminate Non-Food Stamp Eligibility
INXT
пЂє MENU
Other Transactions
F13 is a �HELP’ key in many of these applications
ACEM
HIAR
HOME
пЂє IEVS
PSWD
SOCO
TRAC
TRAT
Assistance to Children in Emergency (ACE)
Health Insurance Action Request Menu
Homeless Program Main Menu
Income and Eligibility Verification System
[F19]
Change MEDS Password On-Line
Share of Cost Obligation
TRAC Information System Main Menu
(Production)
TRAC Information System Main Menu
(Training)
пЂє MOPI
SOCR
Health Access Programs Inquiry Menu
Request for Hold Worker Alert Inquiry
Application Tracking Inquiry Menu
Statewide Inquiry for File Clearance [F22]
Client Inquiry Request [F12]
see list of options in next box
Whole Case Inquiry Request [F23]
Request for Online Worker Alert Inquiry [F20]
Cross Reference File Inquiry Request [F21]
Screens available within INXR:
B BIC-ID (Card) Xrefs
C County-ID Xrefs
H HIC-NO Xrefs
M MEDS-ID Previously Used
N Name Xrefs
X Client Index Number (CIN) Xrefs
Immediate Need County-ID Xref Inquiry
Inquiry Request Menu [F24]
Menu Inquiry Options Include
R INQR Recipient Record [F12]
N INQN Name List [F22]
C INCI
Name List (now INQN)
W INQW Whole Case List [F23]
X INXR Cross Reference File [F21]
S SOCR SOC Case Makeup
T INXT Immediate Need County-ID Xref
K IAPP Application Tracking Inq Menu
A INWA Online Worker Alerts [F20]
H HOLD Worker Alerts for �HOLD’ records
I
IEVS Income/Eligibility Menu [F19]
O HOME Homeless Assistance Pgm Menu
V HIAR Health Insurance System Menu
G HEMI Health Access Programs Menu
Y TRAC TRAC Info System Menu (Prod)
Z TRAT TRAC Info System Menu (Train)
M MOPI Provider Elig Ver Response-POS
MEDS Online POS Inquiry [F11]
Share of Cost Case Make-up Inquiry Request
Revision Date: 9/26/2012
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MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
пЂє INQR
INQS
Client Inquiry Request [F12]
Client Inquiry Summary
The summary screen is presented for each
MEDS-ID selected for detail screens and lists
only those screens with information present,
however all screens are accessible.
Detail MEDS screens available within INQS:
QA
Address Information
QB
Buy-In and BENDEX
QC
Other Health Coverage
QD
Change Dates and Auth Rep Information
QE
Other Client Eligibility Information
QF
Food Stamp
QG
Food Stamp ABAWD Calendar
QH
Health Care Plans 1 through 3
QI
Health Care Plans 4 and 5
QJ
Health Care Plans -- 13-15 months prior
QK
Health Care Plans Capitation Information
QL
Notice of Action (NOA) Information
QM
Medi-Cal/CMSP - Primary
QP
Pending/Denied Applications & Appeals
QQ
Transaction History Info
QT
BENDEX Title II Information
QX
Title XVI - SSI/SSP
Q1
Medi-Cal/CMSP - Special Program 1
Q2
Medi-Cal/CMSP - Special Program 2
Q3
Medi-Cal/CMSP - Special Program 3
Q4
Medi-Cal/CMSP - Pending
Q5
Medi-Cal/CMSP - Future Pending
Q6
Medi-Cal/CMSP - 13-15 Months Prior
Q7
Eligibility by Month (all eligibility for one
month, default is current MEDS MOE, can
select from future pending to 36 months prior)
Q8
Food Stamp History (curr & 36 months prior)
MEDS Inquiry Screen Program Line Information
The eligibility inquiry screens seen from INQR (QM, Q1, Q2, Q3, etc.) have a line
near the middle of the screen showing the status of the eligibility in the various
segments.
Programs:
M
1
2
3
FS
CW
Primary Medi-Cal/CMSP
Special Program 1
Special Program 2
Special Program 3
Food Stamp
CalWORKs
(QM)
(Q1)
(Q2)
(Q3)
(QF)
Status:
(the presence of the value indicates information is available)
C
P
F
H
Current
Pending
Future Pending
History
(Q4)
(Q5)
Special Program Segment Types:
ACCEL
** APPLCN
BCCTP
** CCSGHP
CHDP
CHILD
CMSP
DI/TPN
GR/CAP
HFAMLY
** IE/RR
IH/PCS
MEDICR
TB
Accelerated Enrollment
Application
Breast and Cervical Cancer Treatment
Program
California Children Services / Genetically
Handicapped Persons Program
Child Health Disability & Prevention Program
Children Programs
County Medical Services Program
Dialysis/TPN
General Relief/Cash Assistance Program for
Immigrants
Healthy Families
Ineligible/Responsible Relative
In Home Supportive Services / Personal Care
Services Program
Medicare (QMB, SLMB, QDWI)
Tuberculosis
** Note: these segment types are used during transaction
processing only.
Revision Date: 9/26/2012
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
Page 17 of 19
MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
IMPORTANT PHONE NUMBERS
пЂЁпЂЁ
** NOT TO BE GIVEN OUT TO THE PUBLIC **
MEDS CONTROL DESK (DATA GUIDANCE)
Contact the ITSD Service Desk (see below)
Use this number if there is a problem or question concerning the
printing of reports such as Worker Alerts, SAVE, IEVS, or MEDS
broadcast messages.
LEADER Help Desk
пЂЁ (562) 623-2008
Ombudsman – Dept. of Mental Health
пЂЁпЂ (800) 896-4042
Ombudsman – Managed Care
пЂЁпЂ (888) 452-8609
Use this number if there is a problem or question concerning
medical Managed Care enrollment or disenrollment.
MEDS/IEVS/PROFS/Internet HOTLINE
Call the ITSD Service Desk at
пЂЁ (916) 440-7000
пЂЁ (800) 579-0874
Use this number if there is a problem or question concerning
MEDS processing, missing cards or when instructed by a
MEDS error message.
HHSDC TP HELP DESK
пЂЁ (916) 739-7640
Use this number if there is a problem or question concerning
MEDS or CDB equipment, i.e., terminal won't work, printer won't
print, etc.
MEDS SECURITY COORDINATOR
Contact the ITSD Service Desk (see above)
Use this number for MEDS security or for problems with
passwords, unable to signon, MEDS41 questions, MEDS print
alignment, etc.
HOSPICE REMOVAL
пЂЁ (916) 552-9200 Ask for HOSPICE CLERK.
If no return call, the Hospice Supervisor is
Belinda Cole: (916) 327-0402 or Belinda.Cole@dhcs.ca.gov.
WDTIP Help Desk
пЂЁпЂ (877) 365-7378
WIC
пЂЁпЂ (800) 828-0621
Healthy Families
E-mail address: HFPMEDS@maximus.com
пЂЁпЂ (916) 673-4602
Healthy Families questions should be directed to the e-mail
address shown above.
SPE Liaison
E-mail address: SPELiaisons@maximus.com
пЂЁпЂ (916) 673-4602
Single Point of Entry (SPE) questions should be directed to the
e-mail address or phone number shown above.
TPL (Third Party Liability Branch)
Buy-In
пЂЁпЂ (866) 227-9863
Use this number if there is a problem or question concerning
Buy-In.
Other Health Coverage (OHC)
Fax (916) 650-6582
Use this fax number for DHS6155 requests.
E-mail address: wats@dhs.ca.gov
Fax (916) 229-3385
Use this number if there is a problem or question concerning the
TRAC or TRAT applications.
BCCTP
пЂЁпЂ (800) 824-0088
CMS Help Desk
пЂЁпЂ (916) 327-2378
Case Data Help Desk
пЂЁпЂ (916) 608-3500
CalWIN Solutions Support (Help Desk)
пЂЁпЂ (866) 422-5946 (aka 866-4-CALWIN)
C–IV Help Desk
пЂЁпЂ (866) 828-3054
Revision Date: 9/26/2012
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
Page 18 of 19
MEDS NETWORK USER MANUAL
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
COUNTY MEDS PROGRAM STATUS
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
COUNTY
SYSTEM
ALAMEDA
ALPINE
AMADOR
BUTTE
CALAVERAS
COLUSA
CONTRA COSTA
DEL NORTE
EL DORADO
FRESNO
GLENN
HUMBOLDT
IMPERIAL
INYO
KERN
KINGS
LAKE
LASSEN
LOS ANGELES
MADERA
MARIN
MARIPOSA
MENDOCINO
MERCED
MODOC
MONO
MONTEREY
NAPA
NEVADA
ORANGE
PLACER
PLUMAS
RIVERSIDE
SACRAMENTO
SAN BENITO
SAN BERNARDINO
SAN DIEGO
SAN FRANCISCO
SAN JOAQUIN
SAN LUIS OBISPO
SAN MATEO
SANTA BARBARA
SANTA CLARA
SANTA CRUZ
SHASTA
SIERRA
SISKIYOU
SOLANO
SONOMA
STANISLAUS
SUTTER
TEHAMA
TRINITY
TULARE
TUOLUMNE
VENTURA
YOLO
YUBA
CalWIN 12/05
C-IV
09/10
C-IV
09/10
C-IV
11/10
C-IV
09/10
C-IV
11/10
CalWIN 08/05
C-IV
11/10
C-IV
09/10
CalWIN 07/06
C-IV
09/10
C-IV
11/10
C-IV
05/10
C-IV
05/10
C-IV
05/10
C-IV
05/10
C-IV
09/10
C-IV
11/10
LEADER & Other
C-IV
09/10
C-IV
09/10
C-IV
09/10
C-IV
09/10
C-IV
04/04
C-IV
11/10
C-IV
05/10
C-IV
05/10
C-IV
09/10
C-IV
11/10
CalWIN 02/06
CalWIN 01/05
C-IV
11/10
C-IV
08/04
CalWIN 03/05
C-IV
05/10
C-IV
10/04
CalWIN 06/06
CalWIN 11/05
C-IV
09/10
CalWIN 05/06
CalWIN 10/05
CalWIN 03/06
CalWIN 06/05
CalWIN 05/05
C-IV
11/10
C-IV
11/10
C-IV
11/10
CalWIN 07/05
CalWIN 09/05
C-IV
04/04
C-IV
11/10
C-IV
11/10
C-IV
11/10
CalWIN 01/06
C-IV
09/10
CalWIN 04/06
CalWIN 05/05
C-IV
11/10
CMSP
Yes
Yes
Yes
Yes
Yes
CCS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Note: CMSP Counties are counties that have
contracted with the state to process County
Medical Programs thru MEDS.
Note: CCS Counties are counties that report
California Children Services clients to the state
CMSNET system.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Revision Date: 9/26/2012
Appendices / Appendix D Quick Reference Guides / MEDS Quick Reference Guide
Page 19 of 19