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Medicare Coding
The Medi-Cal record of an individual has Medicare eligibility coding which produces Medicare status codes on the INQM [Medi-Cal/CMSP Information] screen on MEDS. These codes:
- Identify Medicare Part A and/or Part B coverage for eligible Medi-Cal recipients.
- Produce a Medicare eligibility message on the providers POS device indicating that Medicare must be billed prior to billing Medi-Cal.
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Note: EWs can view the message on the “MEDS Online POS Inquiry” (MOPI) screen.
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MC Recipients with Medicare and Other Health Coverage (OHC)
Medi-Cal recipients who have Medicare and supplemental (Medigap) insurance policies (OHC) have the option of suspending their Medicare supplemental insurance coverage premiums for up to 24 consecutive months while they are Medi-Cal eligible.
Medi-Cal recipients who are interested in suspending their Medicare supplemental insurance policies must contact the private insurance company.
Client and EW Action
Once the Medigap premiums are suspended, Medi-Cal recipients with Medicare must immediately contact their eligibility worker, the EW must update the system to reflect the changes.
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