There are several entries into IMU5 which apply specifically to vendor cases. This section provides an overview regarding fields and entries unique to vendor cases. For complete IMU5 instructions, refer to the forms manual.
|FIELD NUMBER||ENTRY REQUIRED|
|Field 2||Enter the vendor facility name.|
|Field 14||Enter the vendor facility name.|
|Field 15B||Enter the vendor facility number. (The number can be obtained from the Medicaid provider List Screen (MPRT).|
|Field 16||Enter date eligible for vendor coverage.|
|Field 22D||Enter the date and amount of the vendor surplus. If surplus amounts vary, enter the date and amount for each surplus.
EXAMPLE: Ms. Y is approved for vendor on December 28. The effective date of her vendor surplus is December 1. Her surplus amount for December is $350.00. Her surplus for January will change to $382.00 because her Social Security income will increase. In this situation, two entries are required in field 22D.
|Field 13E||Enter the effective date for current Medicaid level of care.|
|Field 13G||Enter the level of care code:
|Field 13W||An entry is required in this field for all individuals with an L level of care.
|Field 13V||An entry is required in this field for all individuals with an L level of care. Enter the amount of the individual’s gross income.|
|Field 13X||An entry is required in this field for all persons with an L level of care. This code controls how a case is handled in automatic mass adjustments when standards change.
|Field 13Y||Enter the total shelter expense figure from line 5 of the IM-30E.|