Benefit Issuances - Medical Identification Card
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Benefit Issuances - Medical Identification Card

Revised October 28, 2007

Purpose:

ACES PROCEDURES

See Issuance - Medical ID Card (MAID)

 

CLARIFYING INFORMATION

  1. The ACES system generates a medical identification card (MAID) monthly for client's eligible for medical programs. A MAID is not generated for the following Medicare savings programs:

    1. Qualified Disabled Working Individual (QDWI);

    2. Special Low Income Medicare Beneficiaries (SLMB);

    3. Qualified Individual (QI 1 or QI 2).

  2. A replacement MAID can be generated through the local issuance function of ACES or through the ACES batch system.

  3. Each AU receives a separate MAID.

  4. The information printed on the MAID is derived from two sources; ACES and information passed to ACES from the Medical Assistance Administration (MAA) Medicaid Management Information System (MMIS).

  5. ACES is responsible for the following information printed on the MAID:

    1. CSO address;

    2. Eligibility period;

    3. Client name and address;

    4. CSO number;

    5. AU number;

    6. Primary language (other than English); and

    7. Medical coverage group code.

  6. MAA supplies ACES with the following information which is printed on the MAID:

    1. Level of coverage (e.g., CNP, Family Planning Only, MNP, etc);

    2. The phone number and partial name of any appropriate Healthy Options carrier or primary care case management provider (PCCM);

    3. All of the patient identification code (PIC) data;

    4. Medicare claim number (HIC);

    5. Any restrictions; and

    6. Any other medical coverage information.

  7. ACES does not interface with MAA before generating the initial issuance of a MAID. Because of this, the initial MAIDs do not contain all of the medical coverage information. This will appear on any subsequently issued MAIDs.


SAMPLE MEDICAL ID CARD

Please read the back of this card.

 

MEDICAL IDENTIFICATION CARD

123 Main Street

 

This Card Valid

From: 07/01/1997

Anytown, WA 98000

 

F06

To: 07/31/1997

 

Patient Identification Code (PIC)

Medical Coverage Information

Initials

Birthdate

Last Name

TB

Insurance

Medicare

HMO

Detox

Restriction

Hospice

DD Client

Other

AA

010790

CITIZ

A

 

 

10

11

12

13

14

15

 

 

 

 

 

 

 

 

 

 

 

 

HIC

N/A

16

 

 

 

 

 

 

 

 

 

HIC

547474514A

17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18 A.A. Citizen

19

CNP

123 Main Street

20

Client on Review, etc.

Anytown, WA 98000

21

1-800-xxx-xxxx

 

22

008 004009175

 

23

L0000999*111234B

 

24

 

SHOW TO MEDICAL PROVIDER AT TIME OF EACH SERVICE

(NOT TRANSFERABLE)

DSHS 06-028 (REVISED 8/93) (AC 06/1996)

SIGNATURE (Not Valid Unless Signed)

 


Medical Coverage Group Field on MAID

There is a new field located on the MAID card in the upper right-hand corner next to the validations dates. This code is the ACES medical coverage group code which will identify the type of medical assistance the patient is receiving. Identification of medical coverage group helps providers to determine the need for additional services such as pregnancy-related First Steps services, or if the patient is a potential Healthy Options enrollee.

KEY TO THE MEDICAL ID CARD
AREA DESCRIPTION
  Address of CSO
  Date eligibility begins
  Date eligibility ends
  F06 medical coverage group would be shown for children's CN, etc.

 Patient Identification Code (PIC) Segments Are:
  First and middle initials (or a dash (-) if middle initial is not known)
  Six-digit birth date, consisting of numerals only (MMDDYY)
  First five letters of the last name (and spaces if the name is fewer than five letters
  Tie breaker (an alpha or numeric character)

Medical Coverage Information:
  Insurance carrier code - A four-character alphanumeric code (insurance carrier code) in this area indicates that private insurance plan information.
  Medicare - Xs indicate the client has Medicare coverage.
10 HMO (Health Maintenance Organization) - Indicates enrollment in a MAA Healthy Options managed health care plan. (Managed health care plan is synonymous with health maintenance organization or HMO.) This area may also contain the legend PCCM.
11 Detox - Xs indicate eligibility for a three-day alcohol or a five-day drug detoxification program.
12 Restriction - Xs indicate the client is assigned to one physician and one pharmacist. The word client on review in Area 18 will also indicate restricted clients.
13 Hospice - Xs indicate the client has chosen hospice care.
14 DD client - Xs indicate this person is a client of the DSHS Division of Developmental Disabilities.
15 Other - This area is not in use.
16 HIC is the Medicare Insurance claim number - where there is none the card shows N/A (Not Applicable).
17 HIC shown here indicates that the client is on Medicare.
18 Name and address of client, head of household, or guardian.
19 Program and Scope of Care indicators.
20 Other messages (e.g., client on review, delayed cert.).
21 Telephone number and name of PCCM, or plan.
22 ACES - Local field office (3 digits), assistance unit # (9 digits).
23 Internal control numbers for DSHS use only.
24 Client's signature - May be used to verify identity of client.

Medical coverage group field on MAID

There is a new field located on the MAID card in the upper right-hand corner next to the validations dates.  This code is the ACES medical coverage group code which will identify the type of medical assistance the patient is receiving.  Identification of medical coverage group helps providers to determine the need for additional services such as pregnancy-related First Steps services, or if the patient is a potential Healthy Options enrollee.

 

Medical Coverage Group Codes

Medical Coverage Group Definitions

C01, C04*, C95 and C99

Waiver and Community Based Programs, and Hospice

F01, F02, F03, F04, F10and F09*

Medical assistance for families

F05, F06, F07, F95, F99,

D01 and D02

Medical assistance for children

 

Medical assistance for children in Foster Care or Adoption Support

G01 and G02

General Assistance

G03, G95 and G99

Medical Assistance for a resident of an Adult Living Facility (ALF)

I01

Institution for the Medical Diseased (IMD)

K01,K03*,K95 and K99

Family Long Term Care

L01, L02, L04*, L95 and L99

Long Term Care

M99

Psychiatric Indigent Inpatient

P02, P04*, P99, and S30

 

P05 and P06

Pregnancy and Women’s Health related services

 

 

Family Planning

R01, R02, R03

Refugee

S01,S02, S07*,S95 and S99

Aged, blind or disabled (SSI) or SSI-related

S08

Healthcare for Workers with Disabilities (HWD)

S03, S04, S05 and S06

Medicare savings programs

W01, W02 and W03

* C04, F09, K03, P04 and S07

ADATSA

Coverage under these programs is limited to Emergency and Related Services only for persons not federally qualified for Medicaid due to citizenship or alien status. 

 

 

The following ACES medical coverage groups, if not otherwise exempt, are required to enroll in Healthy Options: F01, F02, F03, F04, F05, F06, , and P02.

 

 

 

WORKER RESPONSIBILITIES

  1. Replacement MAIDs batched from ACES will not contain the appropriate information in the Medical Coverage Information section. Replacement MAIDs printed through the local issuance function of ACES will contain the correct information. Because the information is very important in the delivery of medical services, before taking action to order a replacement MAID, FSSs should always:

    1. Review the information which was printed on the original card by bringing up the benefit history MAID issuance screen; and

    2. Print the replacement MAID through the local function if an entry appears in any of the areas of the Medical Coverage Information section.

  2. Refer clients with questions about:

    1. Third party insurance to the Third party Resource hotline 800-562-6136;

    2. Healthy Options coverage to the plan phone number listed in section 19 on the MAID;

    3. Other questions about medical services to the Medical Assistance Customer Service Center (MACSC) hotline 800-562-3022.

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Modification Date: October 28, 2007
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