Medi-Cal Eligibility Assignment - Cal-PM

Assign Medi-Cal guarantors to clients who are eligible for Medi-Cal coverage or benefits after a service has been rendered.

• Clients with services posted in the date range are compared to the MEDS file to find clients whose name, date of birth, and social security number are compared to MEDS data. The Two Out of Three report details those records in which myAvatar matches two of the three criteria to allow updates to assign or retrieve Medi-Cal eligibility.
• The Medi-Cal payor and plan, as well as the policy number, client index number, and subscriber MEDS ID, are loaded into the financial eligibility record of clients that match the MEDS file.
• For eligible clients with open charges in an open accounting period, liability is assigned to the Medi-Cal payor.

Note: For clients with closed charges, or with eligible services in a closed accounting period, use the Automatic Medi-Cal Revenue Assignment form to transfer liability to the first open accounting period.

• A guarantor must be associated with Medi-Cal (Financial Class field, Guarantors/Payors form).
• A MEDS file must be loaded in myAvatar Cal-PM (California MEDS File Load form).

1. ---

   Go to: Avatar PM > Client Management > Account Management > Medi-Cal Eligibility Assignment

2. In the From Date field, enter the earliest service date.

3. In the To Date field, enter the latest service date.

4. In the Medi-Cal Payor To Assign field, select the Medi-Cal payor.

5. In the Medi-Cal Plan To Assign field, select the Medi-Cal benefit plan. This list contains all non-contract plans (Benefit Plans form).

6. In the Financial Classes Medi-Cal Payor Should Precede field, select the financial classes to go after the Medi-Cal payor in the client financial eligibility.

7. In the Do Not Write Eligibility Records for the Following Aid Codes field, select the aid codes that would exclude assigning a Medi-Cal payor plan.

8. In the Programs To Exclude field:

• Select the treatment programs that should not be covered under the Medi-Cal program.
• The financial eligibility for those client episodes will not be assigned during the compile.

8. In the Do Not Write Eligibility Records For the Following Eligibility Status Codes field, select status codes that would exclude assigning a Medi-Cal payor plan. Separate entries by commas, without spaces.

9. Click the Review Previously Compiled Information button. The Medi-Cal Eligibility Assignment report displays information that has been compiled.
   If a previous file exists, a dialog displays that the current information will be replaced by the new compile.

   • Click Yes to replace the information. A dialog displays the number of records that were assigned coverage.

   • Click No to cancel the compile.