SUBJECT:
DA-124 SCREENS, IMNF
DISCUSSION:
We have developed the IMNF inquiry screens to replace the paper copies of the DA–124 A, B, and C forms sent to counties from Department of Health and Senior Services Central Office Medical Review Unit (COMRU). The screens are available now to those who have access to the NPAP screen. Immediately, begin accessing the screen to check the status of the DA–124s.
Information is available for DA–124s received by COMRU as of August 2004. The county must contact the facility to obtain an admission date for the client. If the client entered the facility before August 2004 or if the DA-124 is not in IMNF, contact COMRU for the DA-124. The worker is responsible for contacting the facility if there is no valid DA-124 (refer to the back of the DA-124 A/B for when a facility must submit a DA-124) for the application or referral. If you are uncertain whether COMRU has completed processing the DA-124s or if you have questions about the data showing on the screens, contact COMRU.
COMRU will discontinue sending paper copies of DA-124s to the counties as of May 13, 2005. Retain a copy of a DA-124 A, B, and C paper form with the instructions on the back for a reference.
DA-124 SCREENS:
The two screens developed are IMNF, DA-124 INQUIRY MENU and I124, DA-124 INQUIRY REPORT. A sample of both screens is attached 
. A date in the “FSD DATE” field on the I124 screen means COMRU has completed its review. Print a copy of the I124 screen, DA-124 Inquiry Report and file in the record as verification of the level of care decision. Refer to the attached INSTRUCTIONS FOR THE DA-124 INQUIRY REPORT for an explanation of the fields on the screen.
LEVEL II SCREENING:
If a Level II screening is indicated on the I124 Inquiry Report (MI CODE or MR CODE), the county will need to wait for the paper copy of the DA-625, LEVEL II NOTIFICATION FOR DFS (FSD) to obtain the date that the earliest date payment could begin.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Immediately begin using the IMNF inquiry.
- Retain a copy of the DA-124 A, B and C paper form with its instructions (on the back of the form) for a reference.