Other Health Coverage Changes/Corrections

Changes to the beneficiary’s OHC can be made not only to the future month, but to current and past month(s) as well. Refer to CalSAWS "JA Other Health Care Detail - Add" for detailed instructions.

OHC Changes for Future Month(s)

A client’s OHC information can be changed for the future month if it is updated PRIOR to current month’s MEDS Renewal. This includes changing from:

No coverage to coverage
Coverage to no coverage, or
Existing insurance carrier to new carrier.

To change OHC information, follow the steps below:

From the Other Health Care Detail page:
- Select the Applicant Name from the Beneficiary multi-select list.
- Click the Health Insurance Company Name Select button.
- On the Select OHC Provider page enter all appropriate information.
- In the Health Insurance Information page section enter the Policy Number in the Policy Number field, Start Date in the Policy Start Date field, and continue entering the appropriate and required information in the remining fields.
- Enter all required information in the Policy Holder Group/Employer Information page section and Health Insurance Details page section.
- Complete the other fields and/or page sections as appropriate.
CalSAWS will generate an EW12 (Modify) batch transaction to MEDS to change the OHC code for the future and continuing months after the case is authorized.

OHC Changes for Current and Prior Months

Only Non-Cost Avoidance OHC codes can be changed for current and prior months via a CalSAWS batch transaction. Changing a Cost Avoidance OHC code for current and/or prior months requires a MEDS online transaction via the MTO.

Reminder: Do not attempt to enter an OHC code on MEDS for a client who had no OHC in the current or any prior month(s) as this is considered an adverse action.

Refer to MC HB Chapter 11: Managed Care, Health Care Options and OHC, Section Cost Avoidance insurance coverage.

Refer to the MEDS QRG for a complete list of OHC codes.

To change OHC information for current and/or prior months:

Follow the steps outlined in “OHC Changes for Future Month(s)” above.
For Non-Cost Avoidance OHC, CalSAWS will generate an EW12 (Modify) batch transaction to change the OHC code for the current and prior month(s) once affected months are re-evaluated.
For Cost Avoidance OHC, submit an SCD 1296 requesting the MTO to change the OHC code online.

Other Health Coverage Changes/Corrections

OHC Changes for Future Month(s)

OHC Changes for Current and Prior Months

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