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Loss of Eligibility Report - Cal-PM

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Generate a report that lists clients who are eligible for Medi-Cal in the past month, but do not show eligibility for the current month.

This report is based on MMEF (Monthly MEDS Extract File) data. It compares the clients in the system with the information on the MMEF (MEDS) file and reports all clients with an ineligible status code on the MMEF (MEDS) file to show that their eligibility has been terminated. The field containing the ineligible status code "999" will be used as the filter for the report.

Data fields in the report include:

  • Avatar Client Number
  • Avatar Client Name
  • Avatar Client Date of Birth (format MM/DD/YYYY)
  • Client Index Number (CIN)
  • All Medi-Cal InEligible Status Month/Year records for the specific date range selected
  1. Go to: Avatar PM > Client Management > Account Management > Loss of Eligibility Report
  2. In the From Date field, enter the report start date.
  3. In the Through Date field, enter the report end date.
  4. Click Process Report.

The system will review every patient's most current MEDS eligibility entry within the date range specified. Only the most current eligibility record is looked at to ensure the system is pulling the most current information for the date range specified.
Note: Patients will be included in this report only when the most current MEDS record (in the SYSTEM.history_meds_elig table) for the date range specified contains an eligibility code indicating a denial. The purpose of the Loss of Eligibility report is to show who, for the given date range, is currently denied from Medi-cal eligibility.

► SQL Tables
  • SYSTEM.history_meds_elig