Burman Hold Process

Burman v. Belshe

The Burman process is the result of the class action lawsuit Burman v. Belshe.
The BIC used by a provider to verify Medi-Cal eligibility through the CA-EVS or the Medi-Cal POS network for any month of eligibility.
The beneficiary is not aware there is a problem with his or her eligibility until the provider receives a not eligible verification response/message. The beneficiary had no advance notice of a system generated Hold or termination.
The settlement of the lawsuit requires that MEDS be modified to suppress the system generated Hold or termination and to continue eligibility at the previous level until the EW resolves the problem or terminates eligibility with a timely NOA.
The Burman Hold report for all offices is available on the 28th of month on the BI. The report ID name is “ALL_Burman_Holds.”

Sample MEDS Screen

The INQM screen displaysINQM screen displays the sign *** HOLD *** on the top left corner when a Burman Hold is created. The Hold is also displayed on the Special Program screens such as INQ1 and INQ2.

When a record is placed on Burman Hold, an eligibility status (ELIG-STAT) code with an "8" appears in the second digit in the month that the Hold is created. The "8" denotes forced issuance. This code can roll into history months if not released.
Burman Hold status does not discontinue or suspend MC eligibility.
Burman Hold status does not cause a beneficiary’s disenrollment from the Medi-Cal Managed Care Health Plan.
Burman Hold status is not reflected in the MEDS Online Provider Inquiry [MOPI] screen, provider POS devices, or provider Medi-Cal POS network.
A system generated termination reason (TERM-REAS) is displayed indicating the reason why the record was placed on a Hold status. The most commonly seen TERM-REAS are listed below.

Code	Termination Reason
B	Hold - Questionable eligibility
J	Hold - Rejected eligibility update in the daily batch process
K	Recon Hold - On MEDS, not on county
L	Recon Hold - Key field discrepancy in County-ID or DOB
M	Recon Hold - Critical eligibility errors on county transaction
N	Recon Hold - Duplicate county records
EE	Exception Eligibles
PP	Pregnancy/FPL/Percentage Program expired

Refer to MEDS QRG on the Reference Materials of Program web page, for additional TERM REAS.

Burman Hold Worker Alert Screens

The Hold worker alert screens were created to provide an online notification of problem(s) identified in the Burman process. This set of online inquiry screens enables the EW to view a record in Burman Hold and identify the problem and take steps towards resolution.
There are three (3) Hold screens. Refer to HOLD - MEDS Worker Alerts for Hold Records for description and how to access the screens.
- Request for Hold Worker Alert Inquiry
- Hold Online Worker Alert Summary
- Hold Online Worker Alert Inquiry Detail
EWs MUST review the case record and take IMMEDIATE corrective action to release the Hold.
Once the error that created the Hold is resolved, the beneficiary’s record will be deleted from the Hold screen. The Hold alert message will continue to display on the INWA screen until purged.
If the Hold status still appears on MEDS after corrective action is taken, the EW should submit an SCD 1296 to have the Hold released online.

Exception Eligibles Tracking Report

Each month after MEDS renewal, the “Exception Eligibles Tracking Reports - Recipient List” for Burman Hold is sent to the County server for download. These alerts is displayed on the “Monthly Renewal MEDS Alerts” listing on the BI and sent to District offices via email.

The two Burman-related categories are:

MEDS Hold-New (First month on Hold): the alert # 9549
MEDS Hold-Old (On Hold for two or more months): the alert # 9550

EWs must IMMEDIATELY review the MEDS alerts for each record and take corrective action within five working days.

Refer to the Calendars on the Program web page, for monthly MEDS renewal dates.

Monthly Management Reports

It is extremely critical that EWs take corrective action to resolve these MEDS errors and remove records from Burman Hold. The state provides monthly management/statistical reports to the counties for control purposes. These reports are included in the Renewal Monthly MEDS Alert listing that is distributed to eligibility staff by a designated MA.

Records which remain uncorrected when the monthly renewal process is run are reported to county management for corrective action. The state will be monitoring each county, providing totals by county and worker of unresolved alerts.

The following management reports are provided by the state:

Number of Current Exception Eligibles by Consecutive Months of Exception Eligibility - Statewide Summary Statistics (RS-MED330-R100)
Number of Current Exception Eligibles by Consecutive Months of Exception Eligibility - Organization Summary Statistics (RS-MED330-R200)
Number of Current Exception Eligibles by Consecutive Months of Exception Eligibility - Eligibility Worker Summary Statistics (RS-MED330-R300).