SUBJECT:
FREQUENTLY ASKED QUESTIONS REGARDING MC+ CHIP CASES INVOICING AND PREMIUM PAYMENT
DISCUSSION:
Following are some common questions regarding MC+ CHIP invoicing and premium payment issues.
Q: If a premium case is closed for non-payment of premium (reason code 62) and the client contacts the worker wanting to have coverage again, should the worker cancel-close the case?
A: No, cases closed due to non-payment of premium to Division of Medical Services (DMS) should not be cancel-closed unless a request for reinstatement is received from the Family Support Division (FSD) Central Office. If a request to reinstate has not been received, the client must reapply.
Q: If a premium case is closed in error by the caseworker, can the case be cancel-closed?
A: Yes, with supervisory approval, premium cases can be cancel-closed when a worker error has resulted in the case being incorrectly closed. The supervisor must then notify Program and Policy that a premium case is being cancel-closed. Program and Policy will then contact the DMS Premium Collections Unit to adjust invoices appropriately due to worker error.
Q: What is the procedure to re-open MC+ premium cases that have been closed due to non-payment of premium?
A: DMS may choose to accept a premium payment on a closed premium case for various reasons. This is not a decision that is made by FSD.
DMS will notify FSD Central Office when a case needs to be reinstated as a result of accepting a payment. FSD Central Office will notify the county caseworker and supervisor listed on ICAS via email to cancel-close and reinstate the case. Instructions outlining the steps to cancel-close the case are included in the e-mail notification.
Q: When an email reinstatement request is received, how long does the worker have to complete the request?
A: The cancel-closing reinstatement must be completed the day received or by close of business the next working day following the request.
Reinstatement of cases in a timely manner is important to ensure clients have access to benefits for which they are eligible. Until reinstatement has been completed, coverage cannot be given for the period of time the premium is to cover. Therefore, priority attention is required for these requests.
Q: Does the county need to know a specific reason why the reinstatement was requested by DMS?
A: No, the specific reason cases are being reinstated is handled by DMS and FSD at Central Office. Follow the instructions to reinstate cases as requested.
FSD and DMS are working on system changes that will alleviate the need for FSD worker intervention. However, until the system changes are made, the manual intervention must be completed as requested.
Q: Are counties required to contact DMS every time they cancel-close or re-approve a case for which reinstatement was requested?
A: Yes. When you receive an email notice and action is completed, follow the instructions provided in the e-mail to contact DMS. DMS cannot complete the required actions to reinstate coverage until notification is received from the FSD eligibility specialist.
Q: If the county contacts DMS will there be a lapse in coverage?
A: When FSD reinstates or re-approves a premium case, a new initial invoice is created. DMS must then manually change the new initial invoice to a recurring invoice and adjust the coverage dates on MPNI. When a client has already re-applied and a reinstatement is requested, the pending application has to be approved. Notify DMS so the invoice can be changed. DMS will then notify the FSD Program and Policy Unit to manually fill-in the lapse in coverage dates as the worker will not be able to give coverage back to the original dates required for reinstatement.
Although original dates are reinstated, when a managed care county cancel-closes a case that was closed for non-payment of premium, it remains closed. When the premium has been paid and the case has been reinstated or re-approved, the recipient will receive coverage on a fee-for-service basis for a period of time until they are enrolled in a managed care plan. Until the recipient has been re-enrolled in a managed care plan, MCII will show the individual enrolled in a pseudo plan. Managed care is not reinstated back to original dates. Coverage is verified by using the red Medicaid card. When managed care is active, coverage is verified by using the managed care card.
Q: How soon after the closing for non-payment of premium is there a lapse in coverage?
A: Currently, when the case closes the coverage ends. Premium cases are date specific. With the cancel-closing and appropriate reinstatement procedures there is no lapse in coverage because a manual intervention is done to restore the original dates and invoicing process. Without manual intervention there will be a lapse in coverage.
Q: What screens can be viewed to verify accurate Medicaid coverage for premium payment children?
A: The MCII screen displays the date the premium was paid and coverage for that premium payment. Enter the DCN for the covered individual to view information on the MCII screen.
Q: Per IM-101, dated 09/01/05, workers have access to MPNI to view the invoice and premium information. The screen shows invoice dates with status of open or closed. Does closed mean the client paid the invoice?
A: If the case status is active and the invoice status is closed on MPNI the client has paid that invoice. MCII will show the date payment was received and coverage dates for the payment.
Q: If a failure to pay notice is showing on MPNI, how can I tell if it's been paid?
A: The failure to pay notice is sent mid-month if the premium payment has not been received. When it has been paid, MPNI will show closed on invoice status. MCII will show the date the payment was received and the coverage given for the payment.
FSD & DMS are currently working on screen enhancements that will make these screens more user-friendly. Help keys are being developed to assist staff in better understanding the screen and the information provided.
Q: What is the difference between eligibility and coverage?
A: The date entered on IMU5 when a child is approved as a premium level case is the eligibility date. This means the client is eligible to purchase premium level of care coverage as of the eligibility date. Level of care 2 cases are eligible to purchase coverage as of the date of application. Level of care 3 cases are eligible to purchase 30 days from the date of application, unless there is a special healthcare needs child. The coverage date is the date the premium payment is received by the DMS Premium Collections Unit or the eligibility date, whichever is later.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.