MEDS Online Transactions Used by MTOs

EW11

MEDS Record Consolidation

LINKS or CHAINS together two MEDS/CDB records for an individual. This is a required action when multiple records for one individual are created. This transaction merges the records together and ‘freezes’ the other record so it can never be used in the future. Under NO circumstances should an MTO ever use it to take over our client’s SSN currently being used erroneously on another person’s record.

EW15

Report Immediate Need Eligibility

Issues an Immediate Need paper BIC, which is used for identification purposes only until the Add (EW20) transaction is received by MEDS. Once the Add transaction is processed by the MEDS Network, a BIC will be issued (for a new recipient) and the EW15 transaction is confirmed.

If the client has a previous MEDS record, their previously issued plastic card will be reactivated when the Add transaction is processed. The EW must also submit a CalSAWS transaction to approve the client; otherwise there will be an unconfirmed immediate need card.

EW30

Modify Individual MEDS Record

The EW30 is used to change information (future or current) for a beneficiary currently eligible on MEDS and to reinstate eligibility for a client inactive on MEDS. The EW30 is also used to confirm current or future eligibility and remove Burman Hold at the same time.

EW31

Modify Individual History/Miscellaneous MEDS Record

The EW31 is an extension of the EW30 transaction. The EW31 is used to modify prior 12-month eligibility information and confirm the eligibility for past months.

EW32

Institutionalized Client Update

• The EW32 is a real-time transaction used to suspend Medi-Cal eligibility for up to one year for an incarcerated minor. The suspension may be viewed from the HIS database, [View Insurance Segment] screen.
• The juvenile may be placed in suspension, released from suspension or the dates may be corrected if the start and/or release date was erroneously entered.
• Medi-Cal benefits are suspended effective the start date indicated on the EW32 screen. Suspension is shown in MEDS with an “I” OHC Code and OHC- SOURCE.
• Medi-Cal benefits are restored immediately effective with the release date entered on the screen. The OHC-SOURCE will be updated to “J” in the month corresponding to the release date. The “I” OHC code will still appear on MEDS until the following month but will not adversely affect the minor’s eligibility once the suspension release date is reported.
• If the suspension is entered for the wrong individual, a request must be made to the State for correction.

EW35

Whole Case Termination/Hold Status Change

EW35 transaction is used to terminate Medi-Cal eligibility or to modify the hold status for all recipients of a case.

EW50

Record Eligibility Over 12 Months Prior

The EW50 transaction is used to record a beneficiary’s eligibility and/or issue cards over 12 prior months to 48 months prior or the MEDS current month including MEC on MEDS.

EW55

SSI/SSP Modify/ID Card Request

Allows our county to correct the sex, DOB, address or Other Health Coverage for SSI/SSP recipients. The recipient must first contact Social Security to notify them of the error/correction (except for OHC changes).

SOCO

Share of Cost Obligation

• Sends a real-time transaction to DHCS to obligate the SOC for a beneficiary. A SOC record must exist on the SOC database.
• If the SOCO transaction results in the full obligation of the SOC, DHCS will generate a SOC certification transaction.
• Once the case has been certified (zero balance), all SOCO transactions will be rejected, including reversal transactions.
• Before reducing the SOC on MEDS, the current SOC obligation for the month must be checked.
• Use the form “Request for SOCO (Share of Cost Obligation) Transaction” (SCD 1296 SOCO) when requesting an online SOCO transaction(s).