2006 Memorandums
IM-93      10/13/06


DA-124C: REPORT #FIM31206-01


A new report will be generated when a Level I Pre-Admission Screening DA-124C for mental Illness (MI), mental retardation (MR), or developmental disability (DD) is completed by the nursing facility and submitted to the Division of Health and Senior Services Central Office Medical Review Unit on an individual who has applied for or is receiving vendor Medicaid. A copy of the report will be sent by e-mail to the Eligibility Specialist and IM Supervisor responsible for the case.

Staff must take appropriate action to verify the information on the report by accessing information entered on the Legacy DA-124 Inquiry screen (IMNF). Complete appropriate case actions based upon the information received.



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