Provider Notice issued 09/17/10

Assistance with Medical Benefits Application and MEDI

The purpose of this notice is to encourage all long term care (LTC) facilities to assist new or current residents who may be close to the asset threshold for eligibility to apply for medical assistance and to also remind providers of the eligibility information they may obtain from the Medical Electronic Data Interchange (MEDI). The Medical Electronic Data Interchange (MEDI) Internet Site (pdf) notice, dated March 25, 2009, was distributed last year when the MEDI system became available to LTC facilities.

A resident who wants benefits may designate an authorized representative to assist with the application. This authorized representative may include facility staff. Upon the request of the resident wanting benefits a facility may accompany, assist and represent them when conducting business with the department. If the person requesting benefits is unable to request assistance with the application process due to incapacity or mental incompetence and has no other representative willing to assist in the process, the LTC facility may be an approved representative. The approval must be in writing and signed by the person who wants the benefits. The signature may be waived if the person wanting benefits is unable to sign the approval. The Department of Human Services Web site contains form IL444-2998, Approved Representative Consent Form (pdf), which can be used for this purpose.

The March 25, 2009, notice (pdf) described the MEDI system as an Internet-based system available free of charge to Medicaid-enrolled providers that allows client eligibility to be verified. LTC facilities are able to perform functions similar to those that have been available through the Recipient Eligibility Verification (REV) system since 2000. An Informational Notice regarding this on-line access was sent to LTC facilities on June 30, 2000. A provider does not have to contract through a REV vendor in order to use the MEDI system. The MEDI and REV systems are separate but both allow provider interaction with the Department’s Medicaid Management Information System (MMIS) through which client eligibility and payment is made among other functions.

The MEDI system utilizes federally approved access protocols that allow only approved providers and their authorized staff to access client information. In order for an LTC facility to enroll they should refer to the Training Page on the MEDI Website.

Once enrolled, the provider will be able to perform an inquiry to determine whether a resident is eligible and enrolled. To complete this inquiry, after signing onto MEDI, the user must enter recipient information into fields on the first inquiry screen. If a Recipient Identification Number is not available, the user must enter any two of the following three data elements to make the inquiry: the resident’s name, date of birth or social security number. If the individual is eligible and enrolled, MEDI will provide relevant details such as: current eligibility status, eligibility for other programs, long term care information, if copayments may be assessed, spend-down status, any third party liability coverage, Medicare coverage information such as Qualified Medicare Beneficiary eligibility, and service limitations due to immigration status.

Providers can also use MEDI to determine whether an individual has an application pending or has applied and been denied enrollment. To obtain that information, the user must complete the last field on the inquiry screen labeled “Pending/Denial.” The user must enter a “Y” for yes prior to submitting the inquiry in order to check for pending or denied applications. A pending message will appear until the application is approved or denied. The denied application message will only appear if an application was denied within a three month period prior to the inquiry date range if using the current date.

Cases are identified as “Pending” on MEDI once they are registered by the DHS Family and Community Resource Center intake worker. Cases are identified as eligible or “Denied” within 1-2 days of disposition of the application by DHS.

Systems information is updated each night so revisions made one day will be available the next through MEDI.

Providers may preview the capabilities of the MEDI system without enrolling by viewing the tutorial titled “Viewlets” that is available on the MEDI Website.

Questions regarding this notice should be directed to the Bureau of Long Term Care at 1-217-782-0545.                                                        

Theresa A. Eagleson, Administrator

Division of Medical Programs