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Other Health Care

Other Health Care. Number 1 Reason for OHC Alerts. The Other Health Coverage screen in ISAWS has not been completed. Number 2 Reason for OHC Alerts ISAWS screen has not been updated. ISAWS Other Health Coverage. To access the Other Health Coverage screen: Select 3 ~ Application Entry

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Other Health Care

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  1. Other Health Care

  2. Number 1 Reason for OHC Alerts • The Other Health Coverage screen in ISAWS has not been completed. Number 2 Reason for OHC Alerts • ISAWS screen has not been updated.

  3. ISAWS Other Health Coverage To access the Other Health Coverage screen: • Select 3 ~ Application Entry • Select 5 ~ Non-Financial Application Entry Menu • Select 9 ~ Health Care Coverage • and enter U/I for Update/Inquiry and the case number.

  4. ISAWS AEHLTH Screen ISAWS AEHLTH HEALTH CARE COVERAGE 05/25/2006 CO: 17 WRKR: 0029 CASE: 0000009 CSLD: 0029 CASE STATUS: OPEN AUTH: CASE NAME: JOE SAMPLE -------------------------------------------------------------------------------------------------------------- Begin: 052006 End: __________ Insurance Co: ________________________ Addr: __________________________ City: ________________ St: _____ Zip: ____________ Phone: _______________ Policy Holder Name: ________________ Absent Parent: ___ (Y/N) SSN: ______________ Policy #: ___________ Type: ____ Group #: ___________ Group Name: _____ Addr: ______________________ City: ___________ St: ______ Zip: _________ Phone: _________ Premium Amt:__________ Frequency: _________ Coverage Begin Date:____________ Coverage End Date: ______________ Persons Covered: ___ ___ ___ ___ ___ ___ ___ -------------------------------------------------------------------------------- MORE: N NEXT SCREEN: ______ PER #: ________ XMIT: _____

  5. ISAWS AEHLTH2 ISAWS AEHLT2 HEALTH CARE COVERAGE 2 05/30/2006 CO: 17 WRKR: 0008 CASE: 0002720 CSLD: 0020 CASE STATUS: PENDING AUTH: 0020 CASE NAME: JOE SAMPLE -------------------------------------------------------------------------------- Begin: 052006 End: HMO: Y (Y/N) Medicare Supplement: N (Y/N) Scope of Coverage: Outpatient: Y (Y/N) Inpatient: Y (Y/N) Medical: Y (Y/N) Pharmacy: Y (Y/N) Dental: N (Y/N) Vision: Y (Y/N) Long Term Care: N (Y/N) Union Name: Union Local Number: HIPP: N (Y/N) Type of Illness: -------------------------------------------------------------------------------- MORE: N NEXT SCREEN: PER #: XMIT:

  6. ISAWS OHC Codes PAY AND CHASE OHC / POST PAYMENT RECOVERY • A Any Carrier (Includes Multiple Coverage) COST AVOIDANCE CODES • C Champus • F Medi-Care HMO • K Kaiser • L Dental Only • P Prepd Hlth/Hlth Maint. (PHP/HMO) PAY AND CHASE OHC/POST PAYMENT RECOVERY • * A Any Carrier (Includes Multiple Coverage) COST AVOIDANCE CODES • C Champus • F Medi-Care HMO • K Kaiser • L Dental Only • P Prepd Hlth/Hlth Maint. (PHP/HMO) • V Any Other Full Scope Carrier

  7. MEDSOther Health Coverage Inquiries • The Health Insurance System contains information about private health insurance that an individual may have. The health insurance information should be useful in responding to beneficiary inquiries and in identifying health insurance carriers. The Health Insurance System is a separate database from MEDS but is included in MEDS for convenience of use. • The HIAR inquiry request screen is obtained either by selecting option "V" from the Main Menu [Shift+F12] or by typing "HIAR" on a blank MEDS screen. [F3]

  8. ACTION REQUEST MENU WELCOME TO THE HEALTH INSURANCE SYSTEM (HIS) ENTER OPTION: V A = Add Beneficiary/Insurance Information C = Change Beneficiary/Insurance Information F = Carrier Master File Menu I = Inquire OHC Code Calendar L = Generate 6155A Letter 0 = OC30 Transaction Q = Auto-OC30 Transaction Generator V = View Insurance Segment MEDS-ID: 555443333 (REQUIRED FOR OPTIONS A, C, I, L, Q, V) CARRIER CODE: (REQUIRED FOR OPTION A) HOLDING FILE KEY: (REQUIRED FOR HOLIDNG RECORD ADD) PF12 = MEDS INQUIRY CLEAR = EXIT

  9. *** VIEW HIS INFORMATION *** OPR – MM/DD/YY (1) DOB: (2) SSN: (3) (4) SEX: (5) CNTY-ID: (6) PND-OHC: (7) CASENAME: (8) CUR-OHC: (9) HIC-NO: (10) BENE-PHONE: ( ) (11) CNTY-NEW-PHONE: ( ) (12) HIQ6155A? (13) HIQDATE: (14) OHC-LETTER: (15) SEGMENT TYPE: INSURANCE (16) SEG 01 OF 01 FOLLOWUP-FLAG: LAST-CHANGE DATE: TRANS-TYPE: OPR: BENE-STATUS: RELATIONSHIP TO P.H.: DEPENDENT-CVG-AVAIL?: CARRIER: CITY: CCODE: POLICY‑HOLDER NAME: LAST FIRST PH-SSN: C/O ADDR: STREET ADDR: CITY/STATE: ZIP: PH-PHONE: ( ) POLICY-NO: ABS-PARENT-INS? (Y/G): POLICY START DATE: STOP DATE: TERM-REAS: UNION NAME: LOCAL NO: EMPLYR/GRP: EMPL/GRP NO: C/O ADDR: STREET ADDR: CITY/STATE: ZIP: PHONE: ( ) SOURCE OF INFO: SCOPE OF COVERAGE: ACTION: ___ (N=NEXT SEG, P=PREV SEG, H=MENU, I=INQUIRY *** PRESS CLEAR TO EXIT

  10. No. Name Description (1) Beneficiary last name followed by first name and middle initial if known. (2) DOB Beneficiary date of birth. (3) SSN Beneficiary Social Security Number (could also be pseudo) (4) Beneficiary address including c/o information if available. (5) SEX F for female and M for male. (6) CNTY-ID Beneficiary County-ID number including county, case serial, FBU and person number. For SSI/SSP recipient the number "9" and the recipient's SSN replaces the County Serial, FBU and Person Number. (7) PND-OHC Pending month for other health coverage. (8) CASE NAME Case name for the beneficiary. (9) CUR-OHC Current month for other health coverage. (10) HIC-NO Medicare Health Insurance Claim number.

  11. No. Name Description (11) BENE-PHONE Beneficiary phone number. (12) CNTY-EW-PHONE County worker phone number. (13) HIQ6155A? HIQ6155A status code: Y - a DHS6155A will be mailed out at end of month. P - a DHS6155A will be mailed out within 90 days. R - response to a 6155A was received from the beneficiary. (14) HIQDATE Date that a response was received to the DHS6155A from field (13). (15) OHC LETTER Currently not in use. (16) SEGMENT TYPE Status of a segment when using the View Insurance Segment options:1 - Active segment8 – Suspended segment (computer generated)9 – Suspended segment (suspend entered by DHS staff) (17) SEGMENT NUMBER Number of segment displayed and relationship to all segments. For example 01 of 01 means there is only 1 segment and it is displayed. (18) FOLLOWUP-FLAG A follow-up flag of "Y" in this field indicates that there is follow-up information on fiche at DHS Health Insurance Unit. (19) LAST-CHANGE-DATE Date of last update transaction.

  12. No. Name Description (20) TRANS-TYPE Transaction type: A – Add C – Change L – Letter V – View (21) OPRDHS Health Insurance Section operator ID for the last operator to update this insurance segment. (22) BENE-STATUS Beneficiary status for this insurance segment: E - active employee R – retiree L – seasonal S – student (23) RELATIONSHIP TO P.H. Relationship to policyholder: D - dependent of policyholder O – other P - policy holder S – spouse of policyholder (24) DEPENDENT-CVG-AVAIL? Dependent coverage availability: Y - yes, N - no. (25) CARRIER Carrier Name from the DHS HIS Carrier Master File. (26) CITY City in which the Health Insurance company is located from the DHS HIS Carrier Master File. (27) CCODE The 4-digit code that corresponds to the Health Insurance HIS Carrier Master File. This code is the record key and is assigned by DHS.

  13. No. Name Description (28) POLICY-HOLDER NAME: Policy Holder’s last name. LAST (29) FIRST Policy Holder’s first name. (30) PH-SSN Policy Holder’s Social Security Number. (31) C/O ADDR Policy Holder's c/o address if available. (32) STREET ADDR Policy Holder's street address. (33) CITY/STATE Policy Holder’s city and state address. (34) ZIP Policy Holder’s zip code. (35) PH-PHONE Policy Holder’s phone number. (36) POLICY-NO Policy Number for this insurance segment.

  14. No. Name Description (37) ABS-PARENT-INS? Absent parent health insurance information:G - absent parent segment was suspended for good cause.Y - the source of health insurance is from an absent parent. (38) POLICY START DATE Date that the health insurance policy became effective if known. Otherwise, the system generates date of onset of Medi-Cal eligibility or three years prior to the segment add date, whichever is most recent. (39) STOP DATE Date that the health insurance policy stopped in known. The system will generate a future date if one is not entered. Currently the system is using December 31, 1999. (40) TERM-REAS Termination reason: H - segment terminated by DHS/HIS. O - segment terminated by any other source. (41) UNION NAME Union name if insurance is through a union. (42) LOCAL NO Union local number if insurance is through a union.

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