Article 9 Section 02 IDX System
Table of Contents
TITLE PG CITE
General 090201A
Recording of Case Activity 090201B
MediCal Status Codes 090201C
CHRONIC Indicator 090201D
CMSPG LTR 25 0513
090201 IDX System
090201A Recording of case activity including some of the different types of
General commentsalert entries and status codes entered on the IDX system assist staff with the processing of CMS cases Refer to Appendix A These historical IDX commentsalerts have been added and are now found on the Main Page of the CMS IT System AuthMed under the Member Alerts tab Refer to Appendix 0901B
Prior to issuing benefits the worker shall
Check for these alerts and entries entered in the Member Alerts tab in AuthMed and
Document the action taken in case comments
CMSPG LTR 25 0513
090201B Case Activity Recording
Disposition
The disposition of every CMS application and recertification is automatically communicated from AuthMed to IDX each night
IDX CommentAlert Entries
Historical IDX member commentsalerts and new Member Alerts have been added to AuthMed and can now be found on the Main Page under the Member Alerts tab Refer to Appendix 0901B
CMSPG LTR 25 0513
090201C IDX status codes are used to track the progress of MediCal referrals MediCal and applications When beneficiaries are approved MediCal Status Codes
090201D CHRONIC Indicator
retroactively CMS bills MediCal for reimbursement and notifies the hospitals and clinics that they need to bill MediCal for services rendered
MediCal Pending AP
This status code identifies beneficiaries who have applied for MediCal and have a case pending in CalWIN or when beneficiaries have an SSI application or SSI appeal pending The worker writes the MediCal application date or the SSI applicationfiling date and level of the SSI appeal in case comments When the beneficiary has a record on MEDS the SSI appeal information is on the MEDS QP screen Workers must document that they asked the beneficiary for an updated status of their MediCal Social Security application or appeal at every interview If there is a change an entry must be made in the case comments
If the beneficiary is approved for MediCal Social Security disability benefits or SSI the worker must immediately forward this information to CMS Recovery by email or fax If an award letter is available a copy of the letter should be attached to the email or fax If the award letter is not available the worker must ask the beneficiary to provide a copy of the award letter to forward to CMS Recovery when received
NOTE Workers must not approve CMS benefits for a beneficiary that has been determined disabled who has a pending
MediCal case
SSISocial Security Disability application or
SSA appeal at the Hearing level
MediCal Approved NA
This status code identifies beneficiaries whose MediCal eligibility has been verified on MEDS
The ASO has the responsibility of entering a CHRONIC indicator on the IDX Eligibility Enrollment Summary Screen for CMS beneficiaries whose chronic medical condition has been identified and verified by claims data in IDX
Before recertifying a CMS case eligibility staff must check the IDX Eligibility Enrollment Summary Screen for the CHRONIC indicator CMS beneficiaries who have the Chronic indicator on the IDX Eligibility Enrollment Summary Screen are to be recertified for twelve months if all program requirements are met Refer to 0803 for recertification instructions for chronics