mmmmm mmmmm eeeeeeee ddd ddd sssssssss mm mm … · mmmmm mmmmm eeeeeeee ddd ddd sssssssss mm mm mm...

MM MM EEEEEEEEEEE DDDDDDDD SSSSSSSSS MMM MMM EEE DDD DDD SSS MMMMM MMMMM EEEEEEEE DDD DDD SSSSSSSSS MM MM MM MM EEE DDD DDD SSSS MM MMM MM EEE DDD DDD SSSS SSSS MM MM EEEEEEEEEEE DDDDDDD SSSSS

Quick Reference Guide Interactive

This guide is interactive.

Click the MEDS screen on the table of contents that you would like information about and it will take you to that page in the document.

Once in the document, click the screen name on the side of the document

to look at information about another MEDS screen.

Items described on the MEDS screen that have a code associated to them will be underlined on the key under the MEDS screen shown.

Click the underlined text to be taken to the page with the codes and what they stand for.

MEDS Password Reset 1-800-579-0874

Updated 06/06/2017

MM MM EEEEEEEEEEE DDDDDDDD SSSSSSSSS MMM MMM EEE DDD DDD SSS MMMMM MMMMM EEEEEEEE DDD DDD SSSSSSSSS MM MM MM MM EEE DDD DDD SSSS MM MMM MM EEE DDD DDD SSSS SSSS MM MM EEEEEEEEEEE DDDDDDD SSSSS

Table of Contents Logging In Inquiry Screens QA—Address Information QB—Buy-in and BENDEX QC—Other Health Coverage QD—Change Dates & AR Information QE—Other Client Eligibility Information QF—Food Stamps QM—Medi-Cal/CMSP QP—Pending/Denied Application and Appeals QT—BENDEX Title II QX—Title XVI-SSI/SSP Q1—Medi-Cal/CMSP Special 1 Q2—Medi-Cal/CMSP Special 2 Q3—Medi-Cal/CMSP Special 3 Q4—Medi-Cal/CMSP Pending Q6—Medi-Cal/CMSP 13-15 Months Prior Q7—Eligibility by Month—Current to prior 36 months Q8—Food Stamp History—Current to prior 36 months Other Screens HI—Health Insurance Screen IEVS—Income & Eligibility Verification System MOPI—MEDS online POS (point of sale) Inquiry EW45—Request Replacement ID Card XB—BIC-ID Cross Reference Report Fuzzy—Statewide Inquiry For File Clearance WA—Worker Alerts MENU X Ref—Cross Reference Screens “F” Keys—Short Cut Keys

LOGGING IN

Type CICSE next to the ===>

Hit Enter

Enter your ID and password Table of Contents

INQUIRY SCREENS

SMITH JOHN 123-45-6789 91234567A

123456789

A = Recipients Last, and First names B = The requested ID number used C = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) D = CIN number E = Birthdate

A A B

C D E

The option list includes all of the MEDS screens that contain data for the individual. Note: All of the inquiry options may or may not be listed for each record.

Table of Contents

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QA = ADDRESS INFORMATION

A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate F = Birthdate Verification G = Physical Address H = Phone Number I = Residence Verification J = County Code K = Address Flag L = Mailing Address

SMITH JOHN 123-45-6789 91234567A 05-01-1950

58

58

(530) 555-5555

PO BOX 123 MARYSVILLE CA 95901 - 1111 - 22 3

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E F

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1234 MAIN ST APT 1 MARYSVILLE CA 95901 - 1111 - 22 3 G

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified

M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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Address Flag

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 Blank—Failed Finalist; presumed mailable 0—BIC mailed-previously Blank 1—BIC returned-previously 0 5—BIC returned-previously W 6—BIC returned-previously X 7—BIC returned-previously Y 9—NOA returned-previously deliverable 2—Failed MEDS validation 3—Foster Care Assistance terminated 4—Residence address but not a mailable address 8—General residence for a homeless customer

Birthdate Verification

C—Client Reported G—Guess (i.e. comatose, abandoned baby) R—Within Range on SSN Verification S—Verified per Reporting System V—Verified per exact NUMIDENT match

Residence Verification

Y—Reported as an address N—Mailing address, may or may not be a residence address

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SMITH JOHN 91234567A 05-01-1950

58

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(530) 555-5555


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123-45-6789

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SMITH JOHN 123-45-6789 91234567A 05-01-1950

58

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County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc

26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama

53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

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QB = BUY-IN & BENDEX

SMITH JOHN 123-45-6789 91234567A

312345678A 312345678901

312345678A

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = HIC-Number G = Code the identifies the County, Federal or State system, which is the primary source of the HIC number. H = Buy-In Eligibility Code I = Date of initial Medicare entitlement J = Buy-In Last Date Change K = Identifies the status of BENDEX reporting L = The last date that BENDEX updated in MEDS M = Part A Eligibility Status (OPT CD) N = Part B Eligibility Status (OPT CD) O = Third Party Started Paying Premium Date P = Payer of the Premium (50=State Pays)

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI

K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = HIC-Number G = Code the identifies the County, Federal or State system, which is the primary source of the HIC number. H = Buy-In Eligibility Code I = Date of initial Medicare entitlement J = Buy-In Last Date Change K = Identifies the status of BENDEX reporting L = The last date that BENDEX updated in MEDS M = Part A Eligibility Status (OPT CD) N = Part B Eligibility Status (OPT CD) O = Third Party Started Paying Premium Date

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QB = BUY-IN & BENDEX

HIC-Number—The letter following the number indicates the type of benefits the recipient is entitled to:

A—Primary claimant (wage earner) B—Aged wife, 62 or over C1-C9—Child-Includes minor, student or disabled child D—Aged widow, age 60 or over E—Widowed Mother

Buy-In Eligibility CD

A—aged recipient of Federal SSI payments B—blind recipient of Federal SSI payments C—entitled to Part A of Title IV (AFDC) D—disabled recipient of Federal SSI payments E—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 (MOA)— (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

OPT—CD

E—Entitled to Part A (Free) Y—Yes to Premium Payment



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SMITH JOHN 123-45-6789 91234567A

312345678A 312345678901

312345678A

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QC = OTHER HEALTH COVERAGE

A = Recipients Last, and First names B = County ID C = MEDS ID D = Social Security Number Verification E = CIN number F = DOB Verification G = HIC Number (Medicare) H= Last time Other Health Care Coverage was updated. I = Death Date, if customer has died, date will show J = Death Code, shows who entered in the date of death K = Line in MEDS that shows which programs are active L = County Code M = Aid Code N = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info O = Type of Other Health Care Coverage P = Source of Other Health Care Coverage Q = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent R = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug)

SMITH JOHN 1234567

391234567A 123-45-6789 91234567A

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County ID—58-M1-1234567-1-02

58—County Code M1—Aid Code 1234567—Case number 1—Family Budget Unit 02—Person Number

R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported



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SSN Verification Continued

N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed

Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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Death Code

B—Medicare Buy-In System Reported Death C—County Welfare Department Worker Reported D—SSN Verification-Vitals Records Electronic Death Notice Per Title XVI E—SSN Verification-Death Date from NUMIDENT F—BENDEX Reported Death Date G—SSN Verification-SSA District Office Reported Death Date Per Title XVI H—SSN Verification-State Reported Death Date Per Title XVI I—SSN Verification-Title II Reported Death Date Per Title XVI J—SSN Verification-Title II Reported Death Date Per Title II K—Medicare Buy-In System Reported L—Deceased per Claim Record (Not Currently Reported in MEDS)

M—MCED Reported Death Date O—Other State/County Worker Reported P—Pickle Update Reported Death Termination R—Returned Mail Marked Deceased S—SDX Reported Title XVI Death Date T—County Reported Death Termination Reason U—MCED Altered Vitals Records Reported V—CA Vitals Records Reported Death Date W—SSN Verification-Returned Check Reported Death Month/Year Per Title XVI X—SSN Verification-Returned Check Reported Deceased Per Title XVI Y—SSN Verification-Deceased Per NUMIDENT File But No Death Date Provided—BENDEX Reported Death Termination Reason

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County Code 01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles

20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin

40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

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Eligibility Status Code—1st Digit

0—Full Scope Medi-Cal with no conditions 1—Full Scope Medi-Cal Long Term Care/SOC 2—LTC/SOC Eligible with one or more conditions 3—Eligible with one or more conditions-Certified SOC, Restricted Services, Minor Consent, CMSP, Limited Scope MC or Partial Health Care Plan Coverage 4—MC Eligible with Full Service HCP Coverage 5—MC or CMSP with an Unmet SOC Obligation 6—Eligible for a Health or Welfare Program other than MC or CMSP (i.e. SLMB, Healthy Families) 7—Hold 8—QMB pending Medicare part A&B Confirmation 9—Ineligible

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Eligibility Status Code—2nd Digit

0—Normal Eligible 1—Unconfirmed Immediate Need eligible reported more than 1 month prior 2—Unconfirmed Immediate Need eligible reported 1 month prior 3—Unconfirmed Immediate Need eligible reported in current month 4—Forced eligible due to late termination 5—Partial Month Eligibility 6—MEDS changed aid code to limited scope due to DRA Citizenship/Identity requirements not met 7—Exception eligible 8—Forced eligible from MEDS hold 9—Full Month Eligibility

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SMITH JOHN 1234567

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OHC Type

A—Any carrier (includes multiple coverage) C—Champus Prime HMO D—Medicare Part D G—Medical Parole F—Medicare RISK HMO I—Institutionalization (Public Institution Coverage) K—Kaiser L—Dental only policies P—PHP/HMO’s & EPO (exclusive provider option) V—Any carrier (other than above) 9—Healthy Families N—None O—Override

Eligibility Status Code—3rd Digit

1—Regular eligible reported timely 2—Regular eligible reported retroactively 3—3 month retroactive eligible 4—Continuing eligible reported timely 5—Continuing eligible reported retroactively 6—Ramos/Pickle/IHSS/Other Extended eligible 7—Aid Paid Pending Ramos/Myers 8—Hold from LTC/SOC status 9—Ineligible or Regular hold

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OHC Source

A—Update from Accelerated Enrollment or AIM C or Blank—County Welfare Department F—Healthy Families 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 X—OHC 9 changed to A based on Foster Care

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Restrict

000—Restriction or Limited Inquiry access removed 001—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


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Restrict Continued Service Restrictions 010/011—Prior authorization required for drugs 050/051—Prior authorization required for scheduled drugs 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


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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 non-cooperation in medical support enforcement overlaid previous S/URS restriction

Medicare Information—3rd Digit

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

Medicare Information—1st & 2nd Digits

0 or Blank—No Coverage 1—Paid 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

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QD = CHANGE DATES & AR INFO

SMITH JOHN 123-45-6789 91234567A

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate F = Birthdate Verification G = Authorized Representative information if known to MEDS H = Renewal dates. In this case, December is the RE month, the last RE was completed in November. I = Last Recertification Date J = Transaction code for the last time benefits were run K = The last entity to have changed benefits on case

SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified

M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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MEDS Transactions

BE30—Bendex Update BINQ—Buy-In Update Request BI30—Buy-In Update Part B BI31—Buy-In Update closed period BI35—Buy-In Update Part A BI37—Buy-In Update Medicare Status Code BI60—Buy-In Exception Deletion Part B BI65—Part A Accretion/Deletion BR30—BRU SOC Certification for Individual DP30—Returned Card/Deceased GZ10—MEDS-ID Number Change (CCS/GHPP) GZ11—MEDS Record Consolidation (CCS/GHPP) GZ12—Update Client Information (CCS/GHPP) GZ20—Add New CCS/GHPP Client HF10—MEDS-ID Number Change (HF only recipient) HF11—MEDS Record Consolidation (HF recipient) HF12—Modify Client Information HF18—Report New HF Application

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HF20—Add New Client HF Eligibility HF30—Modify/Terminate HF Eligibility HF34—Modify Existing HF Application HF40—HF Termination IH05—Transfer County of Responsibility IH12—Update Client Information IH18—Report New Application IH20—Add New Client Record IH34—Modify Application/Appeal Information IH40—HSS/PCSP Termination MB10—MEDS-ID Number Change (MEB) MB11—MEDS Record Consolidation (MEB) MB12—Modify Client Information (MEB) MB13—Update NOA Information MB30—MEB Update MB55—SSI/SSP Modify/ID Card Request MW18—Pending Application (MEB) MW19—Citizenship status/identity verification (MEB) MW20—Add New Client Eligibility (MEB) MW32—Medical Parole Client Update (MEB) MW34—Modify Application/Appeal Information (MEB) MW40—Termination (MEB) OC30—Modify OHC/ID Card Request (Health Insurance Section) PE15—Report Immediate Need Accelerated Enrollment (AE) (Provider) PE18—Report New Application (Provider) PE20—Add New Client AE Eligibility (Provider) PH30—Modify HCP Enrollment Record

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MEDS Transactions Continued

PH40—HCP Disenrollment RB30—Returned BIC RB31—Returned BIC/Deceased SD10—SDX Recipient MEDS-ID Number Change SD20—SDX Recipient Add/Update SD21—Extended Eligibility SP2—Report HF Accelerated Enrollment SS10—SSN Referral Update SS30—SSN Validation Update SU30—S/URS Status Change (Service Restrictions, i.e. hospice, restricted doctor visits, etc.)

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AP18—Report New Application AP20—Report New Application (IEVS or batch) AP22—Save Inquiry (IEVS or batch) AP34—Modify Application/Appeal Information EW03—Exception Correction Update EW05—Transfer County of Responsibility EW10—MEDS-ID Number Change EW11—MEDS Record Consolidation EW12—Update Client Information EW15—Report Immediate Need Eligibility EW20—Add New Client Record EW25—Modify - Whole Case

EW30—Modify Current/Future (Individual) EW31—Modify History/Miscellaneous (Individual) EW32—Institutionalized Client Update EW34—Modify Application/Appeal Information (now AP34) EW35—Termination or Hold - Whole Case EW40—Termination/Hold Status Change (Individual) EW45—Request Replacement ID Card EW50—Eligibility Over 12 Months Prior EW55—SSI/SSP Modify/ID Card Request EW60—Modify Pickle Status Information FR20—Reconcile Food Stamp (batch only) FX05—Transfer County of Responsibility (batch only) FX10—MEDS-ID Number Change (Food Stamp Only Recipient) FX20—Add New Food Stamp Recipient Record FX30—Modify Food Stamp Record (Individual) FX31—Modify Food Stamp Record (allows for ABAWD indicator removal) 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)

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Client Data Change Code

A—Application E—County, Other than Food Stamps F—County, Food Stamps G—CCS/GHPP H—Healthy Families M—Medi-Cal Eligibility Branch O—Other DHS Entity P—Provider reported Gateway eligibility R—Reconciliation update S—Single Point of Entry X—SDX

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = Death Code, shows who entered in the date of death G = Pickle type and status. Identifies classifications for evaluating Pickle eligibility H = Last date a Pickle determination was made I = Date that a pregnant woman is due to deliver unborn child J = Language Code this is the language the customer prefers we speak to them or send documents K = Ethnic Code L = Citizen Document Type Provided M = Citizenship Document number N = Identity Document Provided O = Month and year of entry into the United States or month and year of residence in the United States P = Citizenship or Alien Information Q = Alien Eligibility Code R = The number issued to aliens by the Immigration and Naturalization Service S = County Code, listed under the benefit month

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match

H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process

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Death Code

B—Medicare Buy-In System Reported Death C—County Welfare Department Worker Reported D—SSN Verification-Vitals Records Electronic Death Notice Per Title XVI E—SSN Verification-Death Date from NUMIDENT F—BENDEX Reported Death Date G—SSN Verification-SSA District Office Reported Death Date Per Title XVI H—SSN Verification-State Reported Death Date Per Title XVI I—SSN Verification-Title II Reported Death Date Per Title XVI J—SSN Verification-Title II Reported Death Date Per Title II K—Medicare Buy-In System Reported L—Deceased per Claim Record (Not Currently Reported in MEDS) M—MCED Reported Death Date O—Other State/County Worker Reported P—Pickle Update Reported Death Termination



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X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by

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Death Code Continued R—Returned Mail Marked Deceased S—SDX Reported Title XVI Death Date T—County Reported Death Termination Reason U—MCED Altered Vitals Records Reported V—CA Vitals Records Reported Death Date W—SSN Verification-Returned Check Reported Death Month/Year Per Title XVI X—SSN Verification-Returned Check Reported Deceased Per Title XVI Y—SSN Verification-Deceased Per NUMIDENT File But No Death Date Provided Z—BENDEX Reported Death Termination Reason

Pickle Type 1st digit on QM screen Pickle

Potential Pickle Eligibles

A—Potential Pickle based on aid code C—COLA terminated SSI/SSP eligible M—Potential Pickle moved into state P—Potential Pickle identified by county T—Terminated SSI/SSP recipient also receiving Title II benefits SSP Reduction Eligibles S—5.8% beneficiaries 1992 R—2.7% beneficiaries 1993 Q—2.3% beneficiaries 1994 V—4.9% beneficiaries 1995 No Longer Disabled (NLD) Eligibles D—No Longer Disabled (NLD) adult or child Exception Eligibles I—Terminated IHSS recipient

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Pickle Status 2nd 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 1—Potential Pickle eligible (also posted by MEDS


Pickle Type Continued T—Terminated SSI/SSP recipient—Disabled W—Terminated SSI/SSP recipient—Disabled Widow(er)s X—Terminated SSI/SSP recipient 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). *Pickle Tickler—Persons who must be tracked for

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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 (Used to remove Potential Pickle from 503 Leads and onto Pickle Tickler.) 3—Loss of contact/whereabouts unknown (Used to remove Potential Pickle from 503 Leads and onto Pickle Tickler.) 4—Grandfathered No Longer Disabled (NLD) child 5—Non-Grandfathered No Longer Disabled (NLD) adult or child 7—Remove erroneously reported Potential Pickle (Pickle Type A, M or P) 8—Immediate Need SSI/SSP card issued pending SSA eligibility confirmation (MEDS generated) 9—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

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Language Code

0—American Sign Language (not valid written) 1—Spanish 2—Cantonese 3—Japanese 4—Korean 5—Tagalog 6—Other Non-English 7—English 8—No Valid Date Reported (MEDS Generated) 9—No response, client declined to state A—Other Sign Language (not valid written) B—Mandarin C—Other Chinese Languages D—Cambodian E—Armenian F—Ilocano G—Mien H—Hmong

I—Lao J—Turkish K—Hebrew L—French M—Polish N—Russian P—Portuguese Q—Italian R—Arabic S—Samoan T—Thai U—Farsi V—Vietnamese

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Ethnic Code

1—White 2—Hispanic 3—Black 4—Asian or Pacific Islander 5—Alaskan Native or American Indian 7—Filipino 8—No Valid Data Reported (MEDS Generated) 9—No response, client declined to state A—Amerasian C—Chinese H—Cambodian J—Japanese K—Korean M—Samoan N—Asian Indian P—Hawaiian R—Guamanian T—Laotian V—Vietnamese Z—Other

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Citizenship Document number

1A—US Passport without limitation 1B—Certificate of Naturalization (N-550, N-570) 1C—Certificate of Citizenship (N-560, N-561) 2A—US Public Birth Record before the age of 5 2B—US Citizen based on Collective Naturalization 2C—Certificate of Report of Birth (DS-1350) 2D—Consular Report of Birth Abroad (FS-240) 2E—Certification of Birth Abroad (FS-545) 2F—US Citizen ID Card (I-197, I 1-79) 2G—Northern Mariana ID Card (I-873) 2H—American Indian Card (I-872) with classification of “KIC” 2I—Final Adoption Decree showing the child’s name and a US place of birth 2J—Evidence of US Government civil service before 06/01/1976 2K—Official US Military record showing US place of birth 2L—Proof of adoption under the Child Citizenship Act for a child born outside the US

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2M—US Citizenship verified with SAVE 2Z—SSA Confirmed US Citizenship 3A—Hospital Record with US place of birth 3B—Life or Health Insurance showing US birth 3C—Religious record showing US birth 3D—Early school record showing US birth 3E—US Citizenship verified with CalHEERS through SSA Composite Service 3F—US Citizenship verified with CalHEERS through Verify Lawful Presence Service 4A—Federal or State census record showing US birth and age (usually 1900-1950) 4B—Seneca Indian tribal census showing US birth 4C—Bureau of Indian Affairs Navaho census showing US birth 4D—US Vital Statics official notification of birth 4E—Amended US birth record more than 5 years after the person’s birth 4F—Statement signed by physician or midwife

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present at birth verifying US birth 4G—Admission papers from a nursing facility, skilled care facility or other institution showing a US place of birth 4H—Medical (clinic, doctor or hospital but not immunization) record showing US birth 4I—Roll of Alaska Natives maintained by the Bureau of Indian Affairs 7W—Written Affidavits requires affidavits signed under penalty of perjury by at least two individuals one of whom is not related to the applicant/recipient and who have personal knowledge of the events establishing the client’s claim of citizenship and who are able to prove their own citizenship and identity; also requires a separate affidavit signed under penalty of perjury from the applicant/recipient or other knowledgeable individual explaining why documentary evidence of the claimed of citizenship does not exist or cannot be readily obtained.

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8B—Exempt—Confirmed Current SSI Eligible 8B—Exempt—Confirmed Medicare Eligible 8F—Exempt—Confirmed Current SSI Eligible 8G—Exempt—Confirmed Title II Disability 8J—Exempt—Confirmed Current Foster Care or Adoption Assistance Program 8K—Exempt—Eligible under CalWORKs 8P—Exempt—Eligible under Minor Consent 8Q—Exempt—Eligible under Deemed Infant 8R—Exempt—Abandoned Baby Program eligible born in the US 8S—Exempt—Confirmed Former SSI Eligible 9A—Unable to Obtain—Abandoned baby or child 9B—Unable to Obtain—Amnesia 9C—Unable to Obtain—Comatose client 9D—Unable to Obtain—Otherwise incapacitated

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9J—Unable to Obtain—County ended reasonable opportunity period due to client not making a good faith effort 9P—Unable to Obtain—Client says they cannot afford the cot to obtain an original document or written affidavit 9Q—Unable to Obtain—Client says they cannot locate an acceptable document and cannot get a written affidavit 9R—Unable to Obtain—Client requested end of reasonable opportunity period and did not provide any explanation or acceptable documentation 9S—SSN Verification removal also removed SSA Citizenship/Identity verification—alternate verification pending 9Z—New application who has not yet provided required citizenship documentation

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Identity Document Type

1A—United States Passport issued without limitation 1B—Certificate of Naturalization (Form N-550 or N-570) 1C—Certificate of Citizenship (Form N-560 or N-561) 2A—United States passport issued with limitations 2B—Driver’s license issued by U.S. State or Territory with a photograph or other identifying information such as name, age, sex, race 2C—School identification card with a photograph 2D—U.S. military card or draft record 2E—Identification card issued by Federal, State, or local government with the same information as a driver’s license a photograph or other identifying information such as name, age, sex, 2F—U.S. Military 2G—Certificate of Degree of Indian Blood or other U.S. American Indian/Alaskan Native Tribal document with a photograph or other personal identity information

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2H—U.S. Coast Guard Merchant Mariner card 2Z —SSA confirmed U.S. Citizenship/Identity consistent with SSA data via the State Verification Exchange System (SVES) 5A—Three corroborating identity documents 5B—Written Affidavit signed under penalty of perjury by a residential care facility director or administrator on behalf of a disabled individual institutionalized in the facility 7A—School records including nursery or daycare records for a child under age 16 7B—Clinic, doctor or hospital record for a child under age 16 7W—Written Affidavit signed under penalty of perjury by a parent, guardian or caretaker relative stating the date and place of birth for a child under age 16 (acceptable only when an affidavit was not used for citizenship) 7X—Written Affidavit signed under penalty of perjury by a parent, guardian or caretaker relative stating the date and place of birth for a child age 16 or 17

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Identity Document Type Continued

7Z —Medi-Cal Application signed by a parent or guardian stating the date and place of birth for a child under age 16 (acceptable only when an affidavit was not used for citizenship) 8B —Exempt from Verification—Confirmed Current SSI Eligible 8F—Exempt from Verification—Confirmed Medicare Entitlement 8G—Exempt from Verification—Confirmed receiving Title II Disability Benefits 8J—Exempt from Verification—Eligible under Foster Care or Adoption Assistance Program 8K—Exempt from Verification —Eligible under CalWORKS Cash Assistance Program 8P—Exempt from Verification—Eligible under Minor Consent Program 8Q—Exempt from Verification—Eligible under Deemed Infant Provision

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8R—Exempt from Verification—Abandoned Baby Program eligible born in the U.S. 8S —Exempt from Verification—Confirmed Former SSI Eligible (No Longer SSI Eligible) 9A—Unable to obtain identity documentation— Abandoned baby or child 9B—Unable to obtain identity documentation— Amnesia 9C—Unable to obtain identity documentation— Comatose client 9D—Unable to obtain identity documentation— Client otherwise incapacitated 9J—Unable to obtain identity documentation— County ended reasonable opportunity period due to client not making a good faith effort 9P—Unable to obtain identity documentation—Client says they cannot afford the cost to obtain an original document or written affidavit

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Identity Document Type Continued

9Q—Unable to obtain identity documentation— Client says they cannot locate an acceptable document and cannot get a written affidavit 9R—Unable to obtain identity documentation— Client requested end of reasonable opportunity period and did not provide any explanation or acceptable documentation 9S—SSN Verification removal also removed SSA Citizenship/Identity verification —alternate verification pending 9Z —New applicant who has not yet provided required identity documentation

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Citizen/Alien IND

A—Proven US Citizen B—Alleged US Citizen C—Conditional entrant admitted under INA section 203(a)(7) D—Deportation withheld admitted under INA section 243(h) or 241(b)(3) E—Amerasian refugee admitted under INA sec 207 F—Refugee admitted under INA sec 207 or 203(a)(7) (Federal SDX input only) G—Parolee admitted under INA section 212(d)(5) (Federal SDX input only) H—Silva vs. Levi alien (Federal SDX input only) K—Lawful permanent resident (LPR) L—Asylee admitted under INA section 208 but not Kurdish or Iraqi asylee M—Residents of the Northern Mariana Islands (Federal SDX input only)

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N—Identity and citizenship of the individual verified by the Numident interface (code was previously A or B) (Federal SDX input only) O—Victim of Severe Forms or Trafficking who have been certified by ORR or who has been granted a T Visa P—Pre Jan 1, 1972 alien (presumed lawfully admitted for permanent residence) (Federal SDX input only) Q—Alleged born in US, corroborated by a US birthplace shown on online Numident (Federal SDX input only) R—Other refugee admitted under INA section 207 but not Amerasian or Indochinese refugee S—Other aliens (not a temporary visa holder) T—Alleged PRUCOL U—Undocumented alien V—Visitor/Student/VISA and other aliens with temporary documentation W—Parolee admitted under INA section 212(d)(5) with a period of parole over one year

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Citizen/Alien IND Continued X—Indochinese refugee admitted under INA sec 207 Y—Parolee admitted under INA section 212(d)(5) with a period of parole less than one year Z—Kurdish or Iraqi asylee admitted under INA section 208 0—Other alien (not 1, 5, 7, 8, or 9) obsolete 12/98 1—Indochinese refugee admitted under INA sec 207 obsolete 12/98 5—Citizen child born to refugee parent(s) 7—Other refugee obsolete 12/98 8—Cuban/Haitian entrant 9—Aged alien( Medicare ineligible and not 1,7, or 8) obsolete 12/98

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Alien Eligibility

1—Refugee admitted under section 207 of the INA Federal (SDX) input only 2—Deportation withheld under section 243(h) or 241(b)(3) of the INA, Federal (SDX) input only 3—Lawful Permanent Residence (LPR) with 40 work quarters, Federal (SDX) input only 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 US 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— Non-Citizen 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

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40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen

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A = Case Name (this may be different than the recipient’s name) B = Recipients Last, and First names C = County ID Number D = Eligibility Worker Code - The case worker number of who last ran benefits E = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) F = SSN Verification G = Last Recertification Date H = Birthdate Verification I = Gender J = Primary entity that is responsible for current and/or history eligibility K = The ID Number for another MEDS record that has been permanently linked to this record L = Last time benefits were run for Medi-Cal or CMSP M = Address Flag N = Resident’s County O = The former MEDS ID/Pseudo Number for a MEDS ID for the same recipient that has been updated P = Last time benefits were run for CalFresh Q = Transaction code for the last time benefits were run R = Welfare Program Code shows what programs the customer is on S = Death Code, shows who entered in the date of death T = Date the case was terminated U = Reason the case was terminated V = CIN number W = ABAWD work status X = Date that the ABAWD work status became effective Y = Aid Code for Benefits, in this case 09 is the code for Food Stamps Z = Eligibility Status Code

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate

County ID—58-M1-1234567-1-02


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O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing


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C = County ID Number F = SSN Verification H = Birthdate Verification

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Govt-Resp

1—County Welfare Department (CWD) or MEB controlled eligibility, other than Food Stamps 2—Federal or State controlled Federal continuing 3—Terminated Federal record 6—Other than 1, 2, 3 or 9 May have Food Stamps, IE/RR, CCS, GHPP, and/or Healthy Families 9—Frozen Record

Sex (Gender)

F—Female M—Male U—Unborn N—Not known—Federal (SDX) input only—SDX record had sex code of ‘U’ meaning Unknown


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I = Gender J = Primary entity that is responsible for current and/or history eligibility K = The ID Number for another MEDS record that has been permanently linked to this record M = Address Flag N = Resident’s County

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento

35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

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MEDS Transactions

BE30—Bendex Update BINQ—Buy-In Update Request BI30—Buy-In Update Part B BI31—Buy-In Update closed period BI35—Buy-In Update Part A BI37—Buy-In Update Medicare Status Code BI60—Buy-In Exception Deletion Part B BI65—Part A Accretion/Deletion BR30—BRU SOC Certification for Individual DP30—Returned Card/Deceased GZ10—MEDS-ID Number Change (CCS/GHPP) GZ11—MEDS Record Consolidation (CCS/GHPP) GZ12—Update Client Information (CCS/GHPP) GZ20—Add New CCS/GHPP Client HF10—MEDS-ID Number Change (HF only recipient) HF11—MEDS Record Consolidation (HF recipient) HF12—Modify Client Information HF18—Report New HF Application HF20—Add New Client HF Eligibility HF30—Modify/Terminate HF Eligibility HF34—Modify Existing HF Application HF40—HF Termination IH05—Transfer County of Responsibility IH12—Update Client Information IH18—Report New Application IH20—Add New Client Record IH34—Modify Application/Appeal Information IH40—HSS/PCSP Termination MB10—MEDS-ID Number Change (MEB) MB11—MEDS Record Consolidation (MEB) MB12—Modify Client Information (MEB) MB13—Update NOA Information MB30—MEB Update MB55—SSI/SSP Modify/ID Card Request MW18—Pending Application (MEB) MW19—Citizenship status/identity verification (MEB) MW20—Add New Client Eligibility (MEB) MW32—Medical Parole Client Update (MEB)

MW34—Modify Application/Appeal Information (MEB) MW40—Termination (MEB) OC30—Modify OHC/ID Card Request (Health Insurance Section) PE15—Report Immediate Need Accelerated Enrollment (AE) (Provider) PE18—Report New Application (Provider) PE20—Add New Client AE Eligibility (Provider) PH30—Modify HCP Enrollment Record PH40—HCP Disenrollment RB30—Returned BIC RB31—Returned BIC/Deceased SD10—SDX Recipient MEDS-ID Number Change SD20—SDX Recipient Add/Update SD21—Extended Eligibility SP2—Report HF Accelerated Enrollment SS10—SSN Referral Update SS30—SSN Validation Update SU30—S/URS Status Change (Service Restrictions, i.e. hospice, restricted doctor visits, etc.)

County Transactions

AP18—Report New Application AP20—Report New Application (IEVS or batch) AP22—Save Inquiry (IEVS or batch) AP34—Modify Application/Appeal Information EW03—Exception Correction Update EW05—Transfer County of Responsibility EW10—MEDS-ID Number Change EW11—MEDS Record Consolidation EW12—Update Client Information EW15—Report Immediate Need Eligibility EW20—Add New Client Record EW25—Modify - Whole Case EW30—Modify Current/Future (Individual) EW31—Modify History/Miscellaneous (Individual) EW32—Institutionalized Client Update EW34—Modify Application/Appeal Information (now AP34)

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Death Code

B—Medicare Buy-In System Reported Death C—County Welfare Department Worker Reported D—SSN Verification-Vitals Records Electronic Death Notice Per Title XVI E—SSN Verification-Death Date from NUMIDENT F—BENDEX Reported Death Date G—SSN Verification-SSA District Office Reported Death Date Per Title XVI H—SSN Verification-State Reported Death Date Per Title XVI I—SSN Verification-Title II Reported Death Date Per Title XVI J—SSN Verification-Title II Reported Death Date Per Title II K—Medicare Buy-In System Reported L—Deceased per Claim Record (Not Currently Reported in MEDS) M—MCED Reported Death Date O—Other State/County Worker Reported P—Pickle Update Reported Death Termination Reason R—Returned Mail Marked Deceased S—SDX Reported Title XVI Death Date T—County Reported Death Termination Reason U—MCED Altered Vitals Records Reported V—CA Vitals Records Reported Death Date W—SSN Verification-Returned Check Reported Death Month/Year Per Title XVI X—SSN Verification-Returned Check Reported Deceased Per Title XVI Y—SSN Verification-Deceased Per NUMIDENT File But No Death Date Provided Z—BENDEX Reported Death Termination Reason

County Transactions Continued EW30—Modify Current/Future (Individual) EW31—Modify History/Miscellaneous (Individual) EW32—Institutionalized Client Update EW34—Modify Application/Appeal Information (now AP34) EW35—Termination or Hold - Whole Case EW40—Termination/Hold Status Change (Individual) EW45—Request Replacement ID Card EW50—Eligibility Over 12 Months Prior EW55—SSI/SSP Modify/ID Card Request EW60—Modify Pickle Status Information FR20—Reconcile Food Stamp (batch only) FX05—Transfer County of Responsibility (batch only) FX10—MEDS-ID Number Change (Food Stamp Only Recipient) FX20—Add New Food Stamp Recipient Record FX30—Modify Food Stamp Record (Individual) FX31—Modify Food Stamp Record (allows for ABAWD indicator removal) 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)


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Welfare Program

001—Health Program without CalWORKs 003—Health Program with CalWORKs 004—Food Stamps only 005—Heath Program and Food Stamps 006—Health Program, CalWORKs, and Food Stamps

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Term Reason

01—Discontinuance due to death 03—Discontinuance at recipient request (MC only, CalWORKs/MC) 04—Failure to cooperate (MC only) 05—Increased earnings of father 06—Increased earnings of mother 07—Increased earnings of child 08—Increased earnings of stepfather 09—Other increased earnings in home 17—Increased support—absent parent return 18—Increased support—remarriage of parent 19—Increased support—absent father 20—Term Medi-Cal (allegation of disability) 21—Increased support—other outside source 22—Increased income from OASDI 23—Increased income from other Federal Program 24—Increased income from Veterans benefits 27—Increased income—Unemployment/ Disability Insurance 28—Increased income—other state/local program 29—Increased income—non-government program 32—Increased income from any other source 33—Increased in real property 34—Increased in personal property 35—CalWORKs Term, MEDS eligibility reported under another MEDS-ID by county agency (i.e. Foster Care) 36—”Need” change: law or policy determination 37—Decrease in “need’ 38—Determined ineligible for Medi-Cal only 39—Financial reason not codes 36 or 37 40—Parent no longer incapacitated 44—Resident of a public institution 45—Parent returned home or remarried 46—Change in law or agency policy 47—No longer eligible child in home 48—Loss of legal residence 49—No Program Linkage-other than 38 and 40-48

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50—Refused to comply—property utilities requirement 52—Refused to participate in GAIN program 53—Refused to seek work in program other than GAIN 54—Refused to accept work—EDD referral 55—Refused to accept work—other referral 56—Refused training/education (not GAIN) 57—CalWORKs recipient has been transferred into the SSI program 58—CalWORKs recipient has transferred into another county-administered program 59—Other than 50-70 60—Refused to provide CA7 or Medi-Cal status report 61—Refused to provide essential information (non-CA7) 64—Failed to complete Medi-Cal Midyear Status Review 65—Failed to complete Medi-Cal Annual RV 70—Refused to register with EDD 83—CalWORKs—timed-out adult and family income ineligible 89—Whereabouts unknown—Medi-Cal 93—CalWORKs—transferred to FG from U 94—CalWORKs—transferred to U from FG 95—CalWORKs—transferred to FC from FG or U 96—Transferred to another county 97—Discontinued at recipient request 98—Whereabouts unknown-other than Medi-Cal 99—Other than 01-98 above #AA—Out of State Foster Care (per zip code) A1—Application determined—IE/RR eligibility reported A2—Application determined—Other Medi-Cal eligibility of IH/PCS eligibility reported A3—Application determined—Healthy Families eligibility recorded A4—Application determined—Medi-Cal denial reported

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Term Reason Continued

A5—Application determined—Healthy Families denial reported A6—Application Determined—Healthy Families Gateway terminated on Medi-Cal denial because no Healthy Families referral H1—60 day retro HF disenrollment H2—Program generated HF disenrollment H3—Client requested HF disenrollment H4—Erroneous enrollment H5—Client shows Medi-Cal/Medicare H6—Deceased H7—Decrease in Income, no longer qualifies H8—False declarations H9—Requalification information not provided HA—Annual eligibility review (AER) determined increase in income, no longer qualifies HB—Annual eligibility review determined client covered under other health insurance HC—Proof of citizenship HD—Child link program requirements not met-other HE—Child link program requirements not met due to child HF disenrollment HF—Client shows Medi-Cal / Medicare at AER HG—AER Requalification information not provided HH—Decrease in Income, no longer qualifies at AER HJ—Client requested HF disenrollment at AER HK—Disenrollment due to non-payment of premium HL—Client terminated as a result of Healthy Families Reconciliation CC—CMSP companion without corresponding primary eligibility C1—Death removed via EW03 D1—Death reported via returned card D2—Death reported by MEB D3—Death reported by Vital Statistics D4—Death reported by SDX D5—Death reported by CWD D6—Death reported on Buy-In update D7—Death reported by Healthy Families D8—Death reported on SSN Verification D9—Death reported on BENDEX update EE—Exception eligible FF—Terminated by state via a File Fix IN—Eligibility reported via Immediate Need trans MA—Accelerated BCCTP (time-limited) M1—Terminated by MEB M2—Death removed by MEB, no eligibility M3—Gateway initial enrollment period MB—State only Breast Cancer (time-limited) MC—State only Cervical Cancer (time-limited) OA—Residence outside of California OB—Moved out of state per Buy-In/BENDEX OS—Moved out of state per SDX PP—Pregnancy/FPL/Percentage program expired #RR—On MEDS Not County – Recon termination RT—Recon Data Discrepancy – Closed period ESAC on Legacy trans – Recon Term Date/ Reason used SR—Exceeds 8 month RMA/EMA or RCA/ECA Eligibility SS/S—Renewal terminated after 2 months hold TT—CMSP aid code/non-CMSP county VV—Pickle presumptive termination WW—Renewal terminated current aid code invalid

WW—Renewal terminated current aid code invalid X1—Cessation of Disability-NOA type 23 X2—Cessation of Disability-NOA type CO ZZ—Terminated by MEDS—transitional exceeded maximum months Z1—MEDS established time-limited eligibility

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W = ABAWD work status Z = Eligibility Status Code

ABAWD

0—Not ABAWD 1—ABAWD

Eligibility Status Code

1—Open benefits 9—Benefits Closed

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A = Case Name (this may be different than the recipient’s name) B = Recipients Last, and First names C = County ID D = Eligibility Worker Code - The case worker number of who last ran benefits E = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) F = SSN Verification G = Last Recertification Date H = Birthdate Verification I = Gender J = Primary entity that is responsible for current and/or history eligibility K = The ID Number for another MEDS record that has been permanently linked to this record L = Last time benefits were run for Medi-Cal or CMSP M= Address Flag N = Resident’s County O = The former MEDS ID/Pseudo Number for a MEDS ID for the same recipient that has been updated P = Last time benefits were run for another program Q = Pickle Determination R = Overpayment Recovery Indicator S = Welfare Program Code shows what programs the customer is on T = Death Code, shows who entered in the date of death U = Reason the case was terminated V = CIN number W = HIC Number (Medicare) X = The date the last BIC was ordered. BICs do not automatically re-issue with each application Y = Aid Code for Medi-Cal Z = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info a = Share of cost amount b = Type of Other Health Care Coverage c = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent d = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug) e = Shows which managed care plan customer is enrolled with f = Code for a hold placed on benefits usually making them unable to be used

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate

O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing



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Govt-Resp


Sex (Gender)


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36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito

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Q = Pickle Determination


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 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 (Used to remove Potential Pickle from 503 Leads and onto Pickle Tickler.) 3—Loss of contact/whereabouts unknown (Used to remove Potential Pickle from 503 Leads and onto Pickle Tickler.) 4—Grandfathered No Longer Disabled (NLD) child 5—Non-Grandfathered No Longer Disabled (NLD) adult or child 7—Remove erroneously reported Potential Pickle (Pickle Type A, M or P) 8—Immediate Need SSI/SSP card issued pending SSA eligibility confirmation (MEDS generated) 9—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 Note: *Pickle Status 4 and 5 are associated only with Pickle Type D. *Pickle Type S, R, Q, and V will only show Pickle Status 0. *503 Leads—Includes persons who are terminated from SSI/SSP at the end of December due to the Title II COLA



A—Potential Pickle based on aid code C—COLA terminated SSI/SSP eligible M—Potential Pickle moved into state P—Potential Pickle identified by county T—Terminated SSI/SSP recipient also receiving Title II benefits SSP Reduction Eligibles S—5.8% beneficiaries 1992 R—2.7% beneficiaries 1993 Q—2.3% beneficiaries 1994 V—4.9% beneficiaries 1995 No Longer Disabled (NLD) Eligibles D—No Longer Disabled (NLD) adult or child Exception Eligibles I—Terminated IHSS recipient T—Terminated SSI/SSP recipient—Disabled Adult Child W—Terminated SSI/SSP recipient—Disabled Widow(er)s X—Terminated SSI/SSP recipient 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). *Pickle Tickler—Persons who must be tracked for future Pickle eligibility

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Recovery

Blank—No overpayment 1—CalWORKs overpayment 2—Food Stamp overpayment 3—CalWORKs and Food Stamp overpayment (system generated)

Welfare Program


Death Code


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R = Overpayment Recovery Indicator S = Welfare Program Code shows what programs the customer is on T = Death Code, shows who entered in the date of death

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Term Reason

01—Discontinuance due to death 03—Discontinuance at recipient request (MC only, CalWORKs/MC) 04—Failure to cooperate (MC only) 05—Increased earnings of father 06—Increased earnings of mother 07—Increased earnings of child 08—Increased earnings of stepfather 09—Other increased earnings in home 17—Increased support—absent parent return 18—Increased support—remarriage of parent 19—Increased support—absent father 20—Term Medi-Cal (allegation of disability) 21—Increased support—other outside source 22—Increased income from OASDI 23—Increased income from other Federal Program 24—Increased income from Veterans benefits 27—Increased income—Unemployment/ Disability Insurance 28—Increased income—other state/local program 29—Increased income—non-government program 32—Increased income from any other source 33—Increased in real property 34—Increased in personal property 35—CalWORKs Term, MEDS eligibility reported under another MEDS-ID by county agency (i.e. Foster Care) 36—”Need” change: law or policy determination 37—Decrease in “need’ 38—Determined ineligible for Medi-Cal only 39—Financial reason not codes 36 or 37 40—Parent no longer incapacitated 44—Resident of a public institution 45—Parent returned home or remarried 46—Change in law or agency policy 47—No longer eligible child in home 48—Loss of legal residence 49—No Program Linkage-other than 38 and 40-48

50—Refused to comply—property utilities requirement 52—Refused to participate in GAIN program 53—Refused to seek work in program other than GAIN 54—Refused to accept work—EDD referral 55—Refused to accept work—other referral 56—Refused training/education (not GAIN) 57—CalWORKs recipient has been transferred into the SSI program 58—CalWORKs recipient has transferred into another county-administered program 59—Other than 50-70 60—Refused to provide CA7 or Medi-Cal status report 61—Refused to provide essential information (non-CA7) 64—Failed to complete Medi-Cal Midyear Status Review 65—Failed to complete Medi-Cal Annual RV 70—Refused to register with EDD 83—CalWORKs—timed-out adult and family income ineligible 89—Whereabouts unknown—Medi-Cal 93—CalWORKs—transferred to FG from U 94—CalWORKs—transferred to U from FG 95—CalWORKs—transferred to FC from FG or U 96—Transferred to another county 97—Discontinued at recipient request 98—Whereabouts unknown-other than Medi-Cal 99—Other than 01-98 above #AA—Out of State Foster Care (per zip code) A1—Application determined—IE/RR eligibility reported A2—Application determined—Other Medi-Cal eligibility of IH/PCS eligibility reported A3—Application determined—Healthy Families eligibility recorded A4—Application determined—Medi-Cal denial reported

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A5—Application determined—Healthy Families denial reported A6—Application Determined—Healthy Families Gateway terminated on Medi-Cal denial because no Healthy Families referral H1—60 day retro HF disenrollment H2—Program generated HF disenrollment H3—Client requested HF disenrollment H4—Erroneous enrollment H5—Client shows Medi-Cal/Medicare H6—Deceased H7—Decrease in Income, no longer qualifies H8—False declarations H9—Requalification information not provided HA—Annual eligibility review (AER) determined increase in income, no longer qualifies HB—Annual eligibility review determined client covered under other health insurance HC—Proof of citizenship HD—Child link program requirements not met-other HE—Child link program requirements not met due to child HF disenrollment HF—Client shows Medi-Cal / Medicare at AER HG—AER Requalification information not provided HH—Decrease in Income, no longer qualifies at AER HJ—Client requested HF disenrollment at AER HK—Disenrollment due to non-payment of premium HL—Client terminated as a result of Healthy Families Reconciliation CC—CMSP companion without corresponding primary eligibility C1—Death removed via EW03 D1—Death reported via returned card D2—Death reported by MEB D3—Death reported by Vital Statistics D4—Death reported by SDX D5—Death reported by CWD D6—Death reported on Buy-In update D7—Death reported by Healthy Families D8—Death reported on SSN Verification D9—Death reported on BENDEX update EE—Exception eligibles FF—Terminated by state via a File Fix IN—Eligibility reported via Immediate Need trans MA—Accelerated BCCTP (time-limited) M1—Terminated by MEB M2—Death removed by MEB, no eligibility M3—Gateway initial enrollment period MB—State only Breast Cancer (time-limited) MC—State only Cervical Cancer (time-limited) OA—Residence outside of California OB—Moved out of state per Buy-In/BENDEX OS—Moved out of state per SDX PP—Pregnancy/FPL/Percentage program expired #RR—On MEDS Not County – Recon termination RT—Recon Data Discrepancy – Closed period ESAC on Legacy trans – Recon Term Date/ Reason used SR—Exceeds 8 month RMA/EMA or RCA/ECA Eligibility SS/S—Renewal terminated after 2 months hold TT—CMSP aid code/non-CMSP county VV—Pickle presumptive termination WW—Renewal terminated current aid code invalid X1—Cessation of Disability-NOA type 23

X2—Cessation of Disability-NOA type CO ZZ—Terminated by MEDS—transitional exceeded maximum months Z1—MEDS established time-limited eligibility







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Z = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info b = Type of Other Health Care Coverage

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OHC Type



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QM = MEDI-CAL/CMSP

c = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent

Restrict

000—Restriction or Limited Inquiry access removed 001—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 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 non-cooperation in medical support enforcement overlaid previous S/URS restriction

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Managed Health Care

117—Anthem Blue Cross 142—California Health and Wellness





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QM = MEDI-CAL/CMSP

d = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug) e = Shows which managed care plan customer is enrolled with

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f = Code for a hold placed on benefits usually making them unable to be used

HCPn-STAT (hold code)

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) P4—Pending enrollment—Application accepted S0—Voluntary disenrollment—Capitation recovery processed S1—Active enrollment—Supplemental capitation paid S9—Mandatory disenrollment—Capitation recovery processed

HCPn-REAS (hold reason) Reason for HCP hold status ‘59’

A—Aid code not covered C—County not covered H—OHC exclusion Z—ZIP Code not covered

HCPn-TYPE C—COHS (County Organized Health System) D—Dental H—HMO (Health Maintenance Organization) M—Medical (future use) O—Other

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.

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QP = PENDING/DENIED APPS & APPEAL

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A = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) B = SSN Verification C = Recipients Last, and First names D = Birthdate Verification E = Gender F = Primary entity that is responsible for current and/or history eligibility G = The ID Number for another MEDS record that has been permanently linked to this record H = Last time benefits were run for Medi-Cal or CMSP I = The former MEDS ID/Pseudo Number for a MEDS ID for the same recipient that has been updated J = Last time benefits were run for another program K = Welfare Program Code shows what programs the customer is on L = Death Code, shows who entered in the date of death M = Address Flag N = Resident’s County O = CIN number P = HIC Number (Medicare) Q = The date the last BIC was ordered. BICs do not automatically re-issue with each application R = County ID S = Application Flag T = Date that a pregnant woman is due to deliver unborn child U = Application Status V = Received From/Referred to Entity W = Denial Reason X = Number of persons in the family used to determine PE eligibility Y = Relationship to Applicant Z = Notice of Action Type

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname

T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surnamed V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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Sex (Gender)


B = SSN Verification D = Birthdate Verification E = Gender

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F = Primary entity that is responsible for current and/or history eligibility K = Welfare Program Code shows what programs the customer is on L = Death Code, shows who entered in the date of death M = Address Flag

Welfare Program


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Death Code

B—Medicare Buy-In System Reported Death C—County Welfare Department Worker Reported D—SSN Verification-Vitals Records Electronic Death Notice Per Title XVI E—SSN Verification-Death Date from NUMIDENT F—BENDEX Reported Death Date G—SSN Verification-SSA District Office Reported Death Date Per Title XVI H—SSN Verification-State Reported Death Date Per Title XVI I—SSN Verification-Title II Reported Death Date Per Title XVI J—SSN Verification-Title II Reported Death Date Per Title II K—Medicare Buy-In System Reported L—Deceased per Claim Record (Not Currently Reported in MEDS)

M—MCED Reported Death Date O—Other State/County Worker Reported P—Pickle Update Reported Death Termination Reason R—Returned Mail Marked Deceased S—SDX Reported Title XVI Death Date T—County Reported Death Termination Reason U—MCED Altered Vitals Records Reported V—CA Vitals Records Reported Death Date W—SSN Verification-Returned Check Reported Death Month/Year Per Title XVI X—SSN Verification-Returned Check Reported Deceased Per Title XVI Y—SSN Verification-Deceased Per NUMIDENT File But No Death Date Provided Z—BENDEX Reported Death Termination Reason

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37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino

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County ID—58-M1-1234567-1-02


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Application Flag

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

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

Recv-Ref

CO—County Welfare Department CP—Other County Medical programs FS—Food Stamps HF—Healthy Families IN—Individual MB—Medi-Cal Eligibility Branch, State of California OP—Other program not specifically identified SL—School Lunch Program

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Denial Reason

A—Client Deceased B—Application Withdrawn C—Moved Out of State D—Loss of Contact/Unable to Locate Applicant E—Failure to Cooperate F—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

Rel-To-App

1—Applicant’s child 2—Adult 2’s child 3—Significant other 4—Ex-step parent A—Aunt/Uncle B—Step Child C—Child, common D—Son/Daughter-in-law E—Brother/Sister-in-law F—Foster Child G— Grandparent H—Dependent of a minor dependent I—Mother/Father-in-law J—Brother/Sister K—Grandchild L—Legal Guardianship M—Adoptive Child N—Niece/Nephew O—Other P—Parent Q—Cousin R—Collateral dependent S—Spouse T—Stepfather U—Unborn V—Stepmother W—Ward X—Ex-spouse Y—Yourself (i.e., Applicant) Z—Unknown

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NOA Type

01—Excess Income 02—Persons in Long-Term Care 03—Extended Medi-Cal Eligibility 04—Loss of Residence 05—Deceased 06—Loss of Contact 07—Other 08—Deceased Persons—Returned Card 09—County Eligible 10—Extended Medi-Cal Eligibility: Disabled Adult Child 11—Deceased Persons—State Registrar 12—Disabled Widow(er)s 17—Disabled Medi-Cal, Later Not Found Disabled by SSA 18—Qualifying Individual—1 (QI-1) 19—Qualifying Individual—2 (QI-2) 22—Non-Grandfathered NLD/Blind (second notice) 23—All NLD/Blind (final notice) 26—All NLD/Blind (first notice) 27—Grandfathered NLD/Blind (second notice) 28—All NLD/Blind rescission of county termination 29—Grandfathered NLD/Blind (one-time) 51—Extended Medi-Cal Eligibility: 503 Leads—Pickle 60—MMA Reduction of Benefits

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = Claim number or SSN under which Social Security benefits are paid G = Previous benefit amount being received H = Current benefits amount. This is the amount you use in C-IV I = Date the customer was first entitled to their claim J = The status of the payment listed in the CUR-BENEFIT-AMT field K = Identifies the status of BENDEX reporting L = Last time the benefit amount was reviewed

This screen is used to verify if the applicant/recipient is receiving any type of Social Security Benefits. Income could either be: Social Security Disability (SSD), Social Security Retirement (SSR), Survivors Benefits (SSV)

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available

F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match

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U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = Claim number or SSN under which Social Security benefits are paid G = Previous benefit amount being received H = Current benefits amount. This is the amount you use in C-IV I = Date the customer was first entitled to their claim J = The status of the payment listed in the CUR-BENEFIT-AMT field K = Identifies the status of BENDEX reporting L = Last time the benefit amount was reviewed

This screen is used to verify if the applicant/recipient is receiving any type of Social Security Benefits. Income could either be: Social Security Disability (SSD), Social Security Retirement (SSR), Survivors Benefits (SSV)

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = Identifies the action and source of the last updated posted G = Reason code for Medi-Cal eligibility linked to SSI/SSP H = The last time that there was a change determined with the Social Security benefits I = Social Security payment status codes J = Type of SSI/SSP recipient K = Date that SSI/SSP claim was denied L = Date the customer was first entitled to their claim M = Identifies that individual is eligible under more than one category of eligibility N = Denial Reason O = Amount of total SSI entitlement P = The amount of SSI income received after deductions—cash benefits Q = Other income known to MEDS that is not SSI/SSP, example: Title II R = Amount of total SSP entitlement S = The amount of SSP income received after deductions—cash benefits received as a food supplement T = The date the updated income amount began being paid U = Indicates the recipient’s living arrangement. V = The social security number of someone else associated to the case, such as a spouse or child

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match

U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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Payment Status Code

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 N2—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) No previous payment made (will eventually Replace T30)

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I = Social Security payment status codes N = Denial Reason

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Denial Reason

A—Client Deceased B—Application Withdrawn C—Moved Out of State D—Loss of Contact/Unable to Locate Applicant E—Failure to Cooperate F—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

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Q1 = MC/CMSP SPECIAL PROGRAM 1

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Note: The information on this screen tends to be secondary to primary Medi-Cal aid codes. For example, someone with SSI/SSP will show up with an aid code of 60 on the QM screen. If they also qualify for the Medicare Premium Payment Program, they will show up as also having an aid code of 80 on the Q2 screen. Special programs such as Express Lane Enrollment will also show on these secondary screens.

A = Case Name (this may be different than the recipient’s name) B = Recipients Last, and First names C = County ID D = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) E = SSN Verification F = Last Recertification Date G = Birthdate Verification H = Gender I = Primary entity that is responsible for current and/or history eligibility J = The ID Number for another MEDS record that has been permanently linked to this record K = Last time benefits were run for Medi-Cal program L = Address Flag M = Resident’s County N = The former MEDS ID/Pseudo Number for a MEDS ID for the same recipient that has been updated O = Last time benefits were run for another program P = Pickle Determination Q = Overpayment Recovery Indicator R = Welfare Program Code shows what programs the customer is on S = Death Code, shows who entered in the date of death T = Reason the case was terminated U = CIN number V = HIC Number (Medicare) W = The date the last BIC was ordered. BICs do not automatically re-issue with each application X = Aid Code for Medi-Cal Y = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info Z = Type of Other Health Care Coverage a = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug)

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C = County ID E = SSN Verification

County ID—58-M1-1234567-1-02


SSN Verification




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G = Birthdate Verification H = Gender I = Primary entity that is responsible for current and/or history eligibility L = Address Flag



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M = Resident’s County

32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer


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P = Pickle Determination







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Q = Overpayment Recovery Indicator R = Welfare Program Code shows what programs the customer is on S = Death Code, shows who entered in the date of death

Welfare Program


Death Code

B—Medicare Buy-In System Reported Death C—County Welfare Department Worker Reported D—SSN Verification-Vitals Records Electronic Death Notice Per Title XVI E—SSN Verification-Death Date from NUMIDENT F—BENDEX Reported Death Date G—SSN Verification-SSA District Office Reported Death Date Per Title XVI H—SSN Verification-State Reported Death Date Per Title XVI I—SSN Verification-Title II Reported Death Date Per Title XVI

J—SSN Verification-Title II Reported Death Date Per Title II K—Medicare Buy-In System Reported L—Deceased per Claim Record (Not Currently Reported in MEDS) M—MCED Reported Death Date O—Other State/County Worker Reported P—Pickle Update Reported Death Termination Reason R—Returned Mail Marked Deceased S—SDX Reported Title XVI Death Date T—County Reported Death Termination Reason U—MCED Altered Vitals Records Reported V—CA Vitals Records Reported Death Date W—SSN Verification-Returned Check Reported Death Month/Year Per Title XVI X—SSN Verification-Returned Check Reported Deceased Per Title XVI Y—SSN Verification-Deceased Per NUMIDENT File But No Death Date Provided Z—BENDEX Reported Death Termination Reason

Recovery



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T = Reason the case was terminated

Term Reason

01—Discontinuance due to death 03—Discontinuance at recipient request (MC only, CalWORKs/MC) 04—Failure to cooperate (MC only) 05—Increased earnings of father 06—Increased earnings of mother 07—Increased earnings of child 08—Increased earnings of stepfather 09—Other increased earnings in home 17—Increased support—absent parent return 18—Increased support—remarriage of parent 19—Increased support—absent father 20—Term Medi-Cal (allegation of disability) 21—Increased support—other outside source 22—Increased income from OASDI 23—Increased income from other Federal Program 24—Increased income from Veterans benefits 27—Increased income—Unemployment/ Disability Insurance 28—Increased income—other state/local program 29—Increased income—non-government program 32—Increased income from any other source 33—Increased in real property 34—Increased in personal property 35—CalWORKs Term, MEDS eligibility reported under another MEDS-ID by county agency (i.e. Foster Care) 36—”Need” change: law or policy determination 37—Decrease in “need’ 38—Determined ineligible for Medi-Cal only 39—Financial reason not codes 36 or 37 40—Parent no longer incapacitated 44—Resident of a public institution 45—Parent returned home or remarried 46—Change in law or agency policy

47—No longer eligible child in home 48—Loss of legal residence 49—No Program Linkage-other than 38 and 40-48 50—Refused to comply—property utilities requirement 52—Refused to participate in GAIN program 53—Refused to seek work in program other than GAIN 54—Refused to accept work—EDD referral 55—Refused to accept work—other referral 56—Refused training/education (not GAIN) 57—CalWORKs recipient has been transferred into the SSI program 58—CalWORKs recipient has transferred into another county-administered program 59—Other than 50-70 60—Refused to provide CA7 or Medi-Cal status report 61—Refused to provide essential information (non-CA7) 64—Failed to complete Medi-Cal Midyear Status Review 65—Failed to complete Medi-Cal Annual RV 70—Refused to register with EDD 83—CalWORKs—timed-out adult and family income ineligible 89—Whereabouts unknown—Medi-Cal 93—CalWORKs—transferred to FG from U 94—CalWORKs—transferred to U from FG 95—CalWORKs—transferred to FC from FG or U 96—Transferred to another county 97—Discontinued at recipient request 98—Whereabouts unknown-other than Medi-Cal 99—Other than 01-98 above #AA—Out of State Foster Care (per zip code)


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A1—Application determined—IE/RR eligibility reported A2—Application determined—Other Medi-Cal eligibility of IH/PCS eligibility reported A3—Application determined—Healthy Families eligibility recorded A4—Application determined—Medi-Cal denial reported A5—Application determined—Healthy Families denial reported A6—Application Determined—Healthy Families Gateway terminated on Medi-Cal denial because no Healthy Families referral H1—60 day retro HF disenrollment H2—Program generated HF disenrollment H3—Client requested HF disenrollment H4—Erroneous enrollment H5—Client shows Medi-Cal/Medicare H6—Deceased H7—Decrease in Income, no longer qualifies H8—False declarations H9—Requalification information not provided HA—Annual eligibility review (AER) determined increase in income, no longer qualifies HB—Annual eligibility review determined client covered under other health insurance HC—Proof of citizenship HD—Child link program requirements not met-other HE—Child link program requirements not met due to child HF disenrollment HF—Client shows Medi-Cal / Medicare at AER HG—AER Requalification information not provided HH—Decrease in Income, no longer qualifies at AER HJ—Client requested HF disenrollment at AER HK—Disenrollment due to non-payment of premium HL—Client terminated as a result of Healthy Families Reconciliation CC—CMSP companion without corresponding primary eligibility C1—Death removed via EW03 D1—Death reported via returned card D2—Death reported by MEB D3—Death reported by Vital Statistics D4—Death reported by SDX D5—Death reported by CWD D6—Death reported on Buy-In update D7—Death reported by Healthy Families D8—Death reported on SSN Verification D9—Death reported on BENDEX update EE—Exception eligibles FF—Terminated by state via a File Fix IN—Eligibility reported via Immediate Need trans MA—Accelerated BCCTP (time-limited) M1—Terminated by MEB M2—Death removed by MEB, no eligibility M3—Gateway initial enrollment period MB—State only Breast Cancer (time-limited) MC—State only Cervical Cancer (time-limited) OA—Residence outside of California OB—Moved out of state per Buy-In/BENDEX OS—Moved out of state per SDX PP—Pregnancy/FPL/Percentage program expired #RR—On MEDS Not County – Recon termination

#RR—On MEDS Not County – Recon termination RT—Recon Data Discrepancy – Closed period ESAC on Legacy trans – Recon Term Date/ Reason used SR—Exceeds 8 month RMA/EMA or RCA/ECA Eligibility SS/S—Renewal terminated after 2 months hold TT—CMSP aid code/non-CMSP county VV—Pickle presumptive termination WW—Renewal terminated current aid code invalid X1—Cessation of Disability-NOA type 23 X2—Cessation of Disability-NOA type CO ZZ—Terminated by MEDS—transitional exceeded maximum months Z1—MEDS established time-limited eligibility

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Y = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info Z = Type of Other Health Care Coverage







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a = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug)






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County ID—58-M1-1234567-1-02


SSN Verification




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Welfare Program


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A1—Application determined—IE/RR eligibility reported A2—Application determined—Other Medi-Cal eligibility of IH/PCS eligibility reported A3—Application determined—Healthy Families eligibility recorded A4—Application determined—Medi-Cal denial reported A5—Application determined—Healthy Families denial reported A6—Application Determined—Healthy Families Gateway terminated on Medi-Cal denial because no Healthy Families referral H1—60 day retro HF disenrollment H2—Program generated HF disenrollment H3—Client requested HF disenrollment H4—Erroneous enrollment H5—Client shows Medi-Cal/Medicare H6—Deceased H7—Decrease in Income, no longer qualifies H8—False declarations H9—Requalification information not provided HA—Annual eligibility review (AER) determined increase in income, no longer qualifies HB—Annual eligibility review determined client covered under other health insurance HC—Proof of citizenship HD—Child link program requirements not met-other HE—Child link program requirements not met due to child HF disenrollment HF—Client shows Medi-Cal / Medicare at AER HG—AER Requalification information not provided HH—Decrease in Income, no longer qualifies at AER HJ—Client requested HF disenrollment at AER HK—Disenrollment due to non-payment of premium HL—Client terminated as a result of Healthy Families Reconciliation CC—CMSP companion without corresponding primary eligibility C1—Death removed via EW03 D1—Death reported via returned card D2—Death reported by MEB D3—Death reported by Vital Statistics D4—Death reported by SDX D5—Death reported by CWD D6—Death reported on Buy-In update D7—Death reported by Healthy Families D8—Death reported on SSN Verification D9—Death reported on BENDEX update EE—Exception eligibles FF—Terminated by state via a File Fix IN—Eligibility reported via Immediate Need trans MA—Accelerated BCCTP (time-limited) M1—Terminated by MEB M2—Death removed by MEB, no eligibility M3—Gateway initial enrollment period MB—State only Breast Cancer (time-limited) MC—State only Cervical Cancer (time-limited) OA—Residence outside of California OB—Moved out of state per Buy-In/BENDEX OS—Moved out of state per SDX PP—Pregnancy/FPL/Percentage program expired


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County ID—58-M1-1234567-1-02


SSN Verification




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A1—Application determined—IE/RR eligibility reported A2—Application determined—Other Medi-Cal eligibility of IH/PCS eligibility reported A3—Application determined—Healthy Families eligibility recorded A4—Application determined—Medi-Cal denial reported A5—Application determined—Healthy Families denial reported A6—Application Determined—Healthy Families Gateway terminated on Medi-Cal denial because no Healthy Families referral H1—60 day retro HF disenrollment H2—Program generated HF disenrollment H3—Client requested HF disenrollment H4—Erroneous enrollment H5—Client shows Medi-Cal/Medicare H6—Deceased H7—Decrease in Income, no longer qualifies H8—False declarations H9—Requalification information not provided HA—Annual eligibility review (AER) determined increase in income, no longer qualifies HB—Annual eligibility review determined client covered under other health insurance HC—Proof of citizenship HD—Child link program requirements not met-other HE—Child link program requirements not met due to child HF disenrollment HF—Client shows Medi-Cal / Medicare at AER HG—AER Requalification information not provided HH—Decrease in Income, no longer qualifies at AER HJ—Client requested HF disenrollment at AER HK—Disenrollment due to non-payment of premium HL—Client terminated as a result of Healthy Families Reconciliation CC—CMSP companion without corresponding primary eligibility C1—Death removed via EW03 D1—Death reported via returned card D2—Death reported by MEB D3—Death reported by Vital Statistics D4—Death reported by SDX D5—Death reported by CWD D6—Death reported on Buy-In update D7—Death reported by Healthy Families D8—Death reported on SSN Verification D9—Death reported on BENDEX update EE—Exception eligibles FF—Terminated by state via a File Fix IN—Eligibility reported via Immediate Need trans MA—Accelerated BCCTP (time-limited) M1—Terminated by MEB M2—Death removed by MEB, no eligibility M3—Gateway initial enrollment period MB—State only Breast Cancer (time-limited) MC—State only Cervical Cancer (time-limited) OA—Residence outside of California OB—Moved out of state per Buy-In/BENDEX OS—Moved out of state per SDX PP—Pregnancy/FPL/Percentage program expired


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SMITH JOHN 123-45-6789 91234567A

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match

H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = The ID Number for another MEDS record that has been permanently linked to this record G = Last time benefits were run for Medi-Cal program H = Last time benefits were run for another program I = Case Name (this may be different than the recipient’s name) J = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info K = County ID L = Reason the case was terminated M = Share of Cost Amount

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W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing




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SMITH JOHN 123-45-6789 91234567A

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21—Marin 41—San Mateo 22—Mariposa 42—Santa Barbara 23—Mendocino 43—Santa Clara 24—Merced 44—Santa Cruz 25—Modoc 45—Shasta 26—Mono 46—Sierra 27—Monterey 47—Siskiyou 28—Napa 48—Solano 29—Nevada 49—Sonoma 30—Orange 50—Stanislaus 31—Placer 51—Sutter 32—Plumas 52—Tehama 33—Riverside 53—Trinity 34—Sacramento 54—Tulare 35—San Benito 55—Tuolumne 36—San Bernardino 56—Ventura 37—San Diego 57—Yolo 38—San Francisco 58—Yuba 39—San Joaquin 40—San Luis Obispo

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera

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Term Reason

01—Discontinuance due to death 03—Discontinuance at recipient request (MC only, CalWORKs/MC) 04—Failure to cooperate (MC only) 05—Increased earnings of father 06—Increased earnings of mother 07—Increased earnings of child 08—Increased earnings of stepfather 09—Other increased earnings in home 17—Increased support—absent parent return 18—Increased support—remarriage of parent 19—Increased support—absent father 20—Term Medi-Cal (allegation of disability) 21—Increased support—other outside source 22—Increased income from OASDI 23—Increased income from other Federal Program 24—Increased income from Veterans benefits 27—Increased income—Unemployment/ Disability Insurance 28—Increased income—other state/local program

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34—Increased in personal property 35—CalWORKs Term, MEDS eligibility reported under another MEDS-ID by county agency (i.e. Foster Care) 36—”Need” change: law or policy determination 37—Decrease in “need’ 38—Determined ineligible for Medi-Cal only 39—Financial reason not codes 36 or 37 40—Parent no longer incapacitated 44—Resident of a public institution 45—Parent returned home or remarried 46—Change in law or agency policy 47—No longer eligible child in home 48—Loss of legal residence 49—No Program Linkage-other than 38 and 40-48 50—Refused to comply—property utilities requirement 52—Refused to participate in GAIN program 53—Refused to seek work in program other than GAIN 54—Refused to accept work—EDD referral

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CC—CMSP companion without corresponding primary eligibility C1—Death removed via EW03 D1—Death reported via returned card D2—Death reported by MEB D3—Death reported by Vital Statistics D4—Death reported by SDX D5—Death reported by CWD D6—Death reported on Buy-In update D7—Death reported by Healthy Families D8—Death reported on SSN Verification D9—Death reported on BENDEX update EE—Exception eligibles FF—Terminated by state via a File Fix IN—Eligibility reported via Immediate Need trans MA—Accelerated BCCTP (time-limited) M1—Terminated by MEB M2—Death removed by MEB, no eligibility M3—Gateway initial enrollment period MB—State only Breast Cancer (time-limited) MC—State only Cervical Cancer (time-limited) OA—Residence outside of California OB—Moved out of state per Buy-In/BENDEX OS—Moved out of state per SDX PP—Pregnancy/FPL/Percentage program expired #RR—On MEDS Not County – Recon termination RT—Recon Data Discrepancy – Closed period ESAC on Legacy trans – Recon Term Date/ Reason used SR—Exceeds 8 month RMA/EMA or RCA/ECA Eligibility SS/S—Renewal terminated after 2 months hold TT—CMSP aid code/non-CMSP county VV—Pickle presumptive termination WW—Renewal terminated current aid code invalid X1—Cessation of Disability-NOA type 23 X2—Cessation of Disability-NOA type CO ZZ—Terminated by MEDS—transitional exceeded maximum months Z1—MEDS established time-limited eligibility

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55—Refused to accept work—other referral 56—Refused training/education (not GAIN) 57—CalWORKs recipient has been transferred into the SSI program 58—CalWORKs recipient has transferred into another county-administered program 59—Other than 50-70 60—Refused to provide CA7 or Medi-Cal status report 61—Refused to provide essential information (non-CA7) 64—Failed to complete Medi-Cal Midyear Status Review 65—Failed to complete Medi-Cal Annual RV 70—Refused to register with EDD 83—CalWORKs—timed-out adult and family income ineligible 89—Whereabouts unknown—Medi-Cal 93—CalWORKs—transferred to FG from U 94—CalWORKs—transferred to U from FG 95—CalWORKs—transferred to FC from FG or U 96—Transferred to another county 97—Discontinued at recipient request 98—Whereabouts unknown-other than Medi-Cal 99—Other than 01-98 above #AA—Out of State Foster Care (per zip code) A1—Application determined—IE/RR eligibility reported A2—Application determined—Other Medi-Cal eligibility of IH/PCS eligibility reported A3—Application determined—Healthy Families eligibility recorded A4—Application determined—Medi-Cal denial reported A5—Application determined—Healthy Families denial reported A6—Application Determined—Healthy Families Gateway terminated on Medi-Cal denial because no Healthy Families referral H1—60 day retro HF disenrollment H2—Program generated HF disenrollment H3—Client requested HF disenrollment H4—Erroneous enrollment H5—Client shows Medi-Cal/Medicare H6—Deceased H7—Decrease in Income, no longer qualifies H8—False declarations H9—Requalification information not provided HA—Annual eligibility review (AER) determined increase in income, no longer qualifies HB—Annual eligibility review determined client covered under other health insurance HC—Proof of citizenship HD—Child link program requirements not met-other HE—Child link program requirements not met due to child HF disenrollment HF—Client shows Medi-Cal / Medicare at AER HG—AER Requalification information not provided HH—Decrease in Income, no longer qualifies at AER HJ—Client requested HF disenrollment at AER HK—Disenrollment due to non-payment of premium HL—Client terminated as a result of Healthy Families Reconciliation

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SMITH JOHN 123-45-6789 91234567A 05-01-1950

987-65-432P

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A = Recipients Last, and First names B = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) C = SSN Verification D = CIN number E = Birthdate Verification F = The ID Number for another MEDS record that has been permanently linked to this record G = Last time benefits were run for Medi-Cal program H = Last time benefits were run for another program I = Prior MEDS ID, sometimes used if a customer had a previous Pseudo SSN J = HIC Number (Medicare) K = Death Code, shows who entered in the date of death L = Resident’s County M = Aid Code for Medi-Cal N = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info O = Type of Other Health Care Coverage P = Source of Other Health Care Coverage Q = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent R = Used to report an alien’s aid code for tracking purposes when needed for federal financial participation. Also used for Edwards original aid code.

S = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug) T = Shows which managed care plan customer is enrolled with U = Code for a hold placed on benefits usually making them unable to be used

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SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match

Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing

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SMITH JOHN 123-45-6789 91234567A 05-01-1950

987-65-432P

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K= Death Code, shows who entered in the date of death L = Resident’s County

Table of Contents

Death Code


County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn 12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside

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L = Resident’s County N = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info

Table of Contents

County Code Continued 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba





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N = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info O = Type of Other Health Care Coverage P = Source of Other Health Care Coverage

Table of Contents



OHC Type


OHC Source

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

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Restrict 000—Restriction or Limited Inquiry access removed 001—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 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 non-cooperation in medical support enforcement overlaid previous S/URS restriction

Q = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent

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S = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug) T = Shows which managed care plan customer is enrolled with U = Code for a hold placed on benefits usually making them unable to be used

Table of Contents


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

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) P4—Pending enrollment—Application accepted S0—Voluntary disenrollment—Capitation recovery processed S1—Active enrollment—Supplemental capitation paid S9—Mandatory disenrollment—Capitation recovery processed

HCPn-REAS (hold reason) Reason for HCP hold status ‘59’ A—Aid code not covered C—County not covered H—OHC exclusion Z—ZIP Code not covered






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Q7 = ELIGIBILITY BY MONTH

Table of Contents

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A = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) B = SSN Verification C = Recipients Last, and First names D = Birthdate Verification E = Gender F = Primary entity that is responsible for current and/or history eligibility G = The ID number for another MEDS record that has been permanently linked to this record. H = Last time benefits were run for Medi-Cal or CMSP I = Prior MEDS ID, sometimes used if a customer had a previous Pseudo SSN J = Last time benefits were run for another program K = Welfare Program Code shows what programs the customer is on L = Death Code, shows who entered in the date of death M = Address Flag N = Resident’s County O = CIN number P = HIC Number (Medicare) Q = The date the last BIC was ordered. BICs do not automatically re-issue with each application R = Type of Other Health Care Coverage S = Aid Code T = Source of Other Health Care Coverage U = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent V = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info W = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug) X = Used to report an alien’s aid code for tracking purposes when needed for federal financial participation. Also used for Edwards original aid code.

Y = Date the Medi-Cal share of cost was met Z = Identifies that he recipient is included in multiple SOC FBUs a = Shows which managed care plan customer is enrolled with b = Code for a hold placed on benefits usually making them unable to be used

Y

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B = SSN Verification D = Birthdate Verification

SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified

N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing



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E = Gender F = Primary entity that is responsible for current and/or history eligibility K = Welfare Program Code shows what programs the customer is on L = Death Code, shows who entered in the date of death

Govt-Resp


Sex (Gender)


Welfare Program


D—SSN Verification-Vitals Records Electronic Death Notice Per Title XVI E—SSN Verification-Death Date from NUMIDENT F—BENDEX Reported Death Date G—SSN Verification-SSA District Office Reported Death Date Per Title XVI H—SSN Verification-State Reported Death Date Per Title XVI I—SSN Verification-Title II Reported Death Date Per Title XVI J—SSN Verification-Title II Reported Death Date Per Title II K—Medicare Buy-In System Reported L—Deceased per Claim Record (Not Currently Reported in MEDS) M—MCED Reported Death Date O—Other State/County Worker Reported P—Pickle Update Reported Death Termination Reason R—Returned Mail Marked Deceased S—SDX Reported Title XVI Death Date T—County Reported Death Termination Reason U—MCED Altered Vitals Records Reported V—CA Vitals Records Reported Death Date W—SSN Verification-Returned Check Reported Death Month/Year Per Title XVI X—SSN Verification-Returned Check Reported Deceased Per Title XVI Y—SSN Verification-Deceased Per NUMIDENT File But No Death Date Provided Z—BENDEX Reported Death Termination Reason

Death Code

B—Medicare Buy-In System Reported Death C—County Welfare Department Worker Reported

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Table of Contents

M = Address Flag N = Resident’s County

Address Flag


County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn

12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz 45—Shasta

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Table of Contents

N = Resident’s County R = Type of Other Health Care Coverage T = Source of Other Health Care Coverage

County Code Continued 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

OHC Type


OHC Source

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

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Table of Contents

U = Any restriction that may be placed on the Medi-Cal benefits 1. 1st and 2nd digits=Restricted Service Status 2. 3rd digit of “1”=County Limited Inquiry Access 3. 1st and 2nd digits of “0” with 3rd digit greater than “1”=Minor Consent

Restrict

000—Restriction or Limited Inquiry access removed 001—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 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 non-cooperation in medical support enforcement overlaid previous S/URS restriction

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V = Eligibility Status Code 1. Medi-Cal/CMSP/Other Eligible Status 2. Normal/Exception Eligibility 3. Timelines/Misc. Info







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W = Medicare Information 1. Part A (Hospital) 2. Part B (Medical) 3. Part D (Prescription Drug) a = Shows which managed care plan customer is enrolled with b = Code for a hold placed on benefits usually making them unable to be used

Managed Health Care



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

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) P4—Pending enrollment—Application accepted S0—Voluntary disenrollment—Capitation recovery processed S1—Active enrollment—Supplemental capitation paid S9—Mandatory disenrollment—Capitation recovery processed

HCPn-REAS (hold reason) Reason for HCP hold status ‘59’ A—Aid code not covered C—County not covered H—OHC exclusion Z—ZIP Code not covered






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Q8 = FOOD STAMP HISTORY

Table of Contents

SMITH JOHN JOHN SMITH 58-09-1234567-1-01

123-45-6789

05-01-1950

A A

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P

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A = Recipients Last, and First names B = Case Name (this may be different than the recipient’s name) C = Last time changes were made to CalFresh benefits D = County ID E = Eligibility Worker Code - The case worker number of who last ran benefits F = Transaction code for the last time benefits were run G = MEDS ID, either SSN or Pseudo SSN (often used for newborns or undocs) H = SSN Verification I = Last Recertification Date J = ABAWD work status K = Date that the ABAWD work status became effective L = Birthdate Verification M = Gender N = Primary entity that is responsible for current and/or history eligibility O = CIN number P = Resident’s County Q = Aid Code R = Eligibility Status Code

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D = County ID F = Transaction code for the last time benefits were run

County ID—58-M1-1234567-1-02


County Transactions

AP18—Report New Application AP20—Report New Application (IEVS or batch) AP22—Save Inquiry (IEVS or batch) AP34—Modify Application/Appeal Information EW03—Exception Correction Update EW05—Transfer County of Responsibility EW10—MEDS-ID Number Change EW11—MEDS Record Consolidation EW12—Update Client Information EW15—Report Immediate Need Eligibility EW20—Add New Client Record EW25—Modify - Whole Case EW30—Modify Current/Future (Individual) EW31—Modify History/Miscellaneous (Individual) EW32—Institutionalized Client Update EW34—Modify Application/Appeal Information (now AP34) EW35—Termination or Hold - Whole Case EW40—Termination/Hold Status Change (Individual) EW45—Request Replacement ID Card EW50—Eligibility Over 12 Months Prior EW55—SSI/SSP Modify/ID Card Request EW60—Modify Pickle Status Information

FR20—Reconcile Food Stamp (batch only) FX05—Transfer County of Responsibility (batch only) FX10—MEDS-ID Number Change (Food Stamp Only Recipient) FX20—Add New Food Stamp Recipient Record FX30—Modify Food Stamp Record (Individual) FX31—Modify Food Stamp Record (allows for ABAWD indicator removal) 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)

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H = SSN Verification J = ABAWD work status L = Birthdate Verification

SSN Verification

0—SSN Verification previously reported to MEDS 1—SSN reported by client, not sight verified 2—SSN application filed at SSA office 3—SSN reported by client, sight verified 5—SSN reported by client, SSA referral initiated 6—Client no SSN, SSA referral initiated 8—Client no SSN, unable to get one, undocumented 9—SSN not reported R—SSN Verif Code needs to be removed 7—No valid SSN verification A—SSN verified NUMIDENT, birthdate match B—SSN verified NUMIDENT, birthdate match, Surname did not match C—SSN verified NUMIDENT, no birthdate match D—SSN verified NUMIDENT, no birthdate match, Surname did not match E—SSN verified NUMIDENT, birthdate not available F—SSN verified NUMIDENT, birthdate not available, Surname did not match H—SSN verified via Title II and Title XVI I—SSN verified via Title II J—SSN verified vial Title XVI K—SSN verified via Title II and Title XVI SSN not recognized as issued by SSA L—Verification pending for SSN, sight verified M—Verification pending for SSN, not sight verified N—SSN verif failed NUMIDENT match on birthdate O—SSN verif failed NUMIDENT match on birthdate and failed Title XVI match P—SSN verif failed NUMIDENT match on birthdate and failed Title II match

Q—SSN verif failed NUMIDENT match on birthdate and failed Title II and Title XVI match S—SSN verif failed NUMIDENT match on surname T—SSN verif failed NUMIDENT match on surname and failed Title XVI match U—SSN verif failed NUMIDENT match on surname and failed Title II match V—SSN verif failed NUMIDENT match on surname and failed Title XVI and Title II match W—SSN verified prior to SSN verif process X—SSN verified prior to SSN verif process, but SSN verif removed Y—SSN unverified prior to SSN verif process %—SSN verif failed NUMIDENT, transcription error &—SSN verif failed NUMIDENT, SSN not recognized *—SSN verified SVES SSN process, but SSN verif removed by worker #—SSN verified SVES SSN but SSN removed by SSI/SSP update !—SSN failed NUMIDENT, given name missing



ABAWD

0—Not ABAWD 1—ABAWD

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M = Gender N = Primary entity that is responsible for current and/or history eligibility P = Resident’s County

Govt-Resp


Sex (Gender)


12—Humboldt 13—Imperial 14—Inyo 15—Kern 16—Kings 17—Lake 18—Lassen 19—Los Angeles 20—Madera 21—Marin 22—Mariposa 23—Mendocino 24—Merced 25—Modoc 26—Mono 27—Monterey 28—Napa 29—Nevada 30—Orange 31—Placer 32—Plumas 33—Riverside 34—Sacramento 35—San Benito 36—San Bernardino 37—San Diego 38—San Francisco 39—San Joaquin 40—San Luis Obispo 41—San Mateo 42—Santa Barbara 43—Santa Clara 44—Santa Cruz

County Code

01—Alameda 02—Alpine 03—Amador 04—Butte 05—Calaveras 06—Colusa 07—Contra Costa 08—Del Norte 09—El Dorado 10—Fresno 11—Glenn

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A A

B C

D E F G H I J K

L M N 91234567A O

P

Q

R

P = Resident’s County R = Eligibility Status Code

County Code Continued

45—Shasta 46—Sierra 47—Siskiyou 48—Solano 49—Sonoma 50—Stanislaus 51—Sutter 52—Tehama 53—Trinity 54—Tulare 55—Tuolumne 56—Ventura 57—Yolo 58—Yuba

Eligibility Status Code


OTHER SCREENS

Table of Contents

Listed below are other screens that can be used to determine eligibility or obtain information about the types of services or coverage a customer may have. These screens may also allow one to further assist a customer with their needs. HI—Health Insurance Screen IEVS—Income & Eligibility Verification System MOPI—MEDS online POS (point of sale) Inquiry EW45—Request Replacement ID Card XB—BIC-ID Cross Reference Report Fuzzy—Statewide Inquiry For File Clearance WA—Worker Alerts MENU X Ref—Cross Reference Screens “F” Keys—Short Cut Keys

HI

IEVS

MOPI

EW45 XB Fuzzy WA MENU X Ref F Keys

HI = HEALTH INSURANCE SCREEN

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123456789

The Health Insurance screen acts as a menu option for accessing information regarding other health coverage (OHC) besides Medi-Cal and Medicare. The only screens accessible to county view are the options ‘F’ (offers carrier information) and ‘V’ (provides information on past and current coverage, start/stop dates, policy number and scope of coverage). The most commonly used screen by County employees is the ‘V’ screen.

Select the option you wish to see and press enter

Once on the requested page, hitting enter will return you to the main menu

The F12 key can be used to return to the MEDS Inquiry Request Screen

Next

V

HI

IEVS

MOPI



Table of Contents

SMITH JOHN 123-45-6789


M1 - 1234567 - 1 - 02

JOHN SMITH 312345678A

123-45-6789 JOHN SMITH 1234 MAIN ST APT 1

MARYSVILLE 95901 456789123

The top portion of this screen gives case information like one sees on the inquiry screens

A = Recipients Last, and First names, B = Date of birth, C = Social Security Number, D = Gender, E = County ID, F = Case name (this can be different from the recipient name), G = Address, H = Current type of OHC and I = HIC number.

H

A A B C E

F I G

D

Sex (Gender)


County ID—58-M1-1234567-1-02


OHC Type


Next

HI

IEVS

MOPI



Table of Contents



M1 - 1234567 - 1 - 02

JOHN SMITH 312345678A

123-45-6789 JOHN SMITH 1234 MAIN ST APT 1

MARYSVILLE 95901 456789123

The bottom portion of the page gives the information about the Other Health Care insurance this customer may have. The main information that is used by County Employees from this portion of the screen are:

A = The Insurance Carrier, B = The Policy Holder’s Last, and First names (this may be someone other than recipient, such as a parent or spouse), C = The Policy Number, D = Policy Start Date, E = Policy Stop Date (if there is no date the OHC is considered active and verification is needed from the insurance provider to prove the policy is closed to be able to

request a MEDS update) and F = Who the insurance is provided through, such as an employer.

G = Allows one to see other pages of OHC information by selecting “N” for Next, “P” for Previous Page, etc. Note: If Source of Info has code CSA, this is a child support record that cannot be changed without verification from child support

A

C

B B

D E

F

G

IEVS = INCOME & ELIGIBILITY VERIF SYS

Table of Contents

HI

IEVS

MOPI


IEVS is the Income Eligibility Verification System and is used for the following purpose:

To request an IEVS report. Option “C”

To request an Employment Development Department (EDD) data match, for income

an individual may be receiving from State Disability Insurance (SDI) and Unemployment Insurance Benefits (UIB). Option “E”

To request reported information for an individual from all agencies. Option “I”

To request a Systematic Alien Verification for Entitlements (SAVE) response Option “B”

The system will provide a response for individuals that are know to MEDS. Select the option you wish to review and enter in the SSN/MEDS ID for the individual you require information for. *The most commonly used option by County Employees is “E”

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E

F7

Keyboard Short Cut Shift +


Table of Contents

HI

IEVS

MOPI


123-45-6789 JOHN SMITH

05 01 1950 M

Input the information that you know to request the real time data match from EDD

123-45-6789 JOHN SMITH

05 01 1950 M

N

The record will show the information known to MEDS updated from EDD.

A = The type of benefits that the customer is receiving (In this example SDI), B = The date the benefits began, C = The current benefit amount (SDI is listed daily, UIB is listed weekly), D = The amount of remaining of the current claim.

Please note SDI and UIB are always issued bi-weekly so the current benefit amount will need to be adjusted properly when updating income in C-IV. (ex. UIB 172 weekly amount x 2 = 344, the $344 amount should be used in C-IV)

If there is a potential claim, but benefits aren’t known to MEDS to be issued, they will show in the potential claim area. If a potential claim shows, customers will be required to apply for these benefits.

E = When the customer became eligible to the benefits claim F = The potential weekly benefit amount to be issued.

G = Indicates if an issue needs to be resolved with this income record. If this is an “N” it is ok to use for verification, if it is a “Y” it is not.

A B

C D

E F

G

Option “E” EDD Real Time Match


Table of Contents

HI

IEVS

MOPI


Option “I” Information for an Individual from all agencies

123-45-6789 58- M1 - 1234567 - 1 - 02

JOHN SMITH 05-01-1950

58- M1 - 1234567 - 1 - 02

58– 09 - 1234567 - 1 - 02

JOHN SMITH JOHN SMITH

05-01-1950

When Option “I” is selected and a record is known to MEDS, one of two screens will show. If M702 No Record Found pops up, there is not a report record known to MEDS to use, however one may find income information with the EDD Real Time Match Option “E”

Individual Inquiry Summary (the most common)

Inquiry with Multiple Segments—if this comes up, pick your segment and it will take you to

the Individual Inquiry Summary. Select the option you wish to view. Only highlighted options contain information.

MOPI = MEDS ONLINE POS INQUIRY

Table of Contents

HI

IEVS

MOPI


123456789 07 01 2015

The MEDS Online Provider Inquiry (MOPI) mirrors what doctors and pharmacies see when they are verifying eligibility of a patient. Enter the recipient ID (MEDS ID/SSN or CIN) and the date of service (within the last 12 months) to review information. Issue Date and Birth Month will auto-populate if there is a match.

123456789 07 01 2015

SMITH 1234AB5C6D

#312345678A

If a match exists, then you will see the primary eligibility code appear with all applicable information such as:

Share of Cost (SOC)

Other Health Coverage (OHC)

Any coverage restrictions

Managed Care provider enrollment

F11

Keyboard Short Cut

EW45 = REQUEST REPLACEMENT ID CARD

Table of Contents

HI

IEVS

MOPI


58 M1 1234567 1 02

123456789

58 M1 1234567 1 02

123456789

This screen is used to request a replacement Medi-Cal Benefits Identification Card (BIC) for a customer. A temporary BIC can be printed in the office that is good for use for 90 days from the date of issuance and a permanent BIC can be ordered to be mailed. Permanent BICs take 7-10 business days to arrive and cannot be printed in the County office.

To print a temporary BIC, enter in the County ID, MEDS ID and the birthdate. In the Card Issue Site, type SCRN (for screen) and hit enter. If the information is correct the CIN will auto-populate and a screen will pop up with the temporary BIC for printing. Whenever a paper BIC is ordered, a new benefits number is generated, so a permanent BIC will also need to be ordered with the updated information.

To order a replacement BIC, enter in the County ID, MEDS ID and the birthdate. In the Card Issue Site, type MEDS and hit enter. If the information is correct the CIN will auto-populate and a confirmation code will show at the bottom of the screen that says, “C100D card request accepted, card print initiated.” All required information for this screen can be found on the QM screen.

F9

Keyboard Short Cut

XB = BIC-ID CROSS REFERENCE REPORT

Table of Contents

HI

IEVS

MOPI

EW45

XB Fuzzy WA MENU X Ref F Keys

123-45-6789

91234567C890123

This screen will tell one the most current BIC information.

A = The full BIC number B = If this is a permanent card (BIC) or temporary card (PAPER) C = The date the BIC was issued (some doctor’s offices need this information to run benefits) D = The BIC’s expiration date. This will show when a paper card expires or if a permanent BIC that was issued is no longer valid. The most current permanent BIC should not have a date in this column. Please note that information from this page may only be given verbally to a customer if they are at a doctor’s office seeking medical attention and do not have their card, or at a pharmacy picking up a prescription and do not have their card. The information cannot be given to the doctor or pharmacist. If the customer needs this information and does not meet these criteria, for example they do not have a their card, but have an appointment later that day, a temporary BIC can be issued and a new permanent BIC may be ordered.

A B C D

Fuzzy = STATEWIDE INQUIRY FOR FILE CLEARANCE

Table of Contents

HI

IEVS

MOPI

EW45 XB

Fuzzy WA MENU X Ref F Keys

The Statewide Inquiry for File Clearance screen is commonly used to search a newborn baby, undocumented individuals who may not have a social security number, or other individuals being added to a case record. A search may be done using the following information:

Address

Last Name, First Name

Date of Birth

Once the information is entered, MEDS will give information about that person that is known to the MEDS system. This is a good tool to use to find a MEDS ID for someone whose ID may be something other than a social security number.

F10


WA = WORKER ALERTS

Table of Contents

HI

IEVS

MOPI

EW45 XB Fuzzy

WA MENU X Ref F Keys

The INQS screen (The initial landing screen for searching for an individual) will inform of how many alerts are associated to this case and need to be reviewed. Typing in WA on this screen will lead one to the alert screen.


123-45-6789 91234567A 05-01-1950

SMITH JOHN SMITH JOHN 58- M1 - 1234567 - 1 - 02 123-45-6789 05-01-1950

The WA screen will show the alerts that need to be addressed.

MEDS alerts are system notifications that inform the user that there are changes that require attention, inconsistent or discrepant information, or simply that a change has occurred to a record.

Types of alerts include Daily Alerts that are generated by batch processes or by users who can make changes to MEDS, Renewal Alerts to show pending changes to eligibility, and Reconciliation Alerts which are done by review of counties every quarter for discrepancies between county systems and MEDS or duplicate records.

Important: MEDS alerts that are not reviewed may cause a hold to be placed on benefits.

F8


MENU = INQUIRY REQUEST MENU

Table of Contents

HI

IEVS

MOPI

EW45 XB Fuzzy WA

MENU X Ref F Keys

Some of the menus one may not be able to access as easily from the INQR screen that most inquiries will start with, will be accessible on the Inquiry Request Menu or MENU screen, such as: MEDS worker alerts or the TRAC menu (allows for a statewide search of CalWORKs and TANF Time On Aid records). Entry to all of the inquiry options available on MEDS and some of the available keyboard shortcuts are available on this screen.

F12


X REF = CROSS REFERENCES

Table of Contents

HI

IEVS

MOPI

EW45 XB Fuzzy WA MENU

X Ref F Keys

These screens are used to cross reference various data known to MEDS

XC shows all cases a person has ever been on in all 58 California Counties

XN shows all names a person has been known under

XX shows all CINs that are associated to an individual

123-45-6789

51-M1-1234567-2-01 99-12345678P 51-M1-7654321-2-18 48-IE-1234567-0-04 48-M1-7654321-0-04 58-M1-1234567-2-01

123-45-6789

SMITH SMITH SMITH SMITH SMITH JONES

JOHN JOHN JOHN JOHN JOHN JOHN

123-45-6789

91234567A

“F” KEYS = KEYBOARD SHORTCUTS

Table of Contents

HI

IEVS

MOPI

EW45 XB Fuzzy WA MENU X Ref

F Keys

F9

Replacement BIC

F11

MOPI Screen

F12

QR Screen Individual Look up

Shift

+ F7

IEVS Menu

Shift

+ F8

Worker Alerts

Shift

+ F9

Cross Reference Menu (X screens)

Shift

+ F10

Fuzzy Name Search

Shift

+ F11

Case Lookup

Shift

+ F12

MENU

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