Guarantor Selection Section

Select the guarantor and enter guarantor and subscriber information.

1. Next to the Guarantor Information table, click the Add New Item button.

2. In the Guarantor # field, enter the guarantor number, click the Search button, and select the corresponding entry.

3. In the Guarantor Name field, edit the guarantor name if appropriate.

4. In the Guarantor Plan field, select the benefit plan.

5. In the Customize Guarantor Plan field:

• Select Yes to customize the benefit plan. Yes is available if Yes is selected for the guarantor in the Allow Customization Of Guarantor Plan field (Guarantors/Payors form).
• Select No to use the default benefit plan information.

6. In the 'Guarantor’s Address' fields, the guarantor’s demographic information should default from the Guarantors/Payors form.

7. In the Inhibit Billing By Mail field:

• Select Yes to prevent creating a claim, and printing a bill for the client.
• Select No to allow client billing of the guarantor.
  This field is used for self-pay guarantors, and works with paper billing.

8. In the Is This A Managed Care Contract field,

• Select Yes for managed care contracts.
• Select No for all other contracts.

9. In the Effective Date Of Contract field, enter the first day guarantor liability can be distributed.

10. In the Expiration Date Of Contract field, enter the last day guarantor liability can be distributed.

11. In the Insurance Code/Medicaid Tape field, enter the insurance code for the Medicaid tape.

12. In the Eligibility Verified field:

• Select Yes if client eligibility has been verified.
• Select No if client eligibility has not been verified. If No is selected, liability does distribute on the client ledger and is not included in an interim billing batch.

13. In the Coverage Effective Date field, enter the first coverage date. Services dated on or after this date can be distributed to the guarantor. When a client is eligible for Medi-Cal guarantor, this date will be equal to the oldest file date in the SYSTEM.history_meds_elig  table.

14. In the Coverage Expiration Date field, enter the last coverage date. Services dated on or after this date will not be distributed to the guarantor.

15. In the Client’s Relationship To Subscriber field, select the relation. The Default Client Demographic Information extended dictionary controls whether client demographic information populates the following fields (from the Update Client Data form):

16. In the Subscriber demographic fields, enter information as appropriate.

17. In the Subscriber Address - County field, select the county.

18. In the Subscriber Branch/Service field, select the subscriber's military service.

19. In the Subscriber Military Status field, select the subscriber's military status.

20. In the Subscriber’s Employment Status field, select the employment status.

21. In the Subscriber's Employer fields, enter the appropriate information.

22. In the Subscriber Group Name field, enter the group name for the subscriber.

23. In the Subscriber Group # field, enter the group name for the subscriber.

24. In the Subscriber Policy # field, enter the subscriber policy number. The policy number is required for electronic billing.
    This field is required when the extended element Require Policy # For This Financial Class? off of the Financial Class dictionary is set to Yes.

25. In the Subscriber Medicare # field, enter the client's Medicare number.

26. In the Subscriber Treatment Auth. field, select Yes if the subscriber is authorized for treatment.

27. In the Subscriber Assignment Of Benefits field, select Yes if the subscriber has authorized payments to be sent directly to the provider.

28. In the Subscriber Release Of Info field, select the release authorization status/type. Select Yes if the subscriber authorizes the release of client benefit information.

29. In the Coordination Of Benefits field, select Yes if benefits are synchronized between multiple guarantors in a client’s financial eligibility.

30. In the Date Of Accident field, enter the accident date if applicable.

31. In the Date Benefits Terminated field, enter the termination date if applicable. This field does not affect liability distribution.

32. In the Date Benefits Denied field, enter the denial date if applicable. This field does not affect liability distribution.

33. In the Denial Code field, select the code.

34. In the Subscriber’s Covered Days field, enter the maximum number of room and board days that can be charged to the guarantor, for all levels of the benefit plan (per the Plan Definition form). This number overwrites the benefit plan, if the number is less than the total dollars entered for all benefit plan levels.

35. In the Number Of Days For Interim Billing field, enter the number interim billing days. This is the number of days from the last batch bill date before the guarantor can be included in another interim billing batch.

36. In the Maximum Covered Dollars field, enter the maximum number of dollars that can be charged to the guarantor, for all levels of the benefit plan. This number overwrites the plan if it is less than the total dollars entered in all levels of the plan.

37. In the Lifetime Reserve Days field, enter the total number of reserve days.

38. The 'Medi-Cal Eligibility' fields are populated by data from the MEDS record with the latest effective date. These fields do not affect liability distribution.

• If there is a MEDS record for the effective date, and the eligibility code or aid code does not match the Eligibility Code or Aid Code fields, the values in these fields will populate the MEDS record.
• If there is no MEDS record for the effective date, a new record will be created.
• The values in this table will be used to populate the MEDS file.

39. In the Subscriber Medicaid # field, enter the number.

40. In the Eligibility Inquiry (270) Status field, select the status of the eligibility inquiry.

41. In the Eligibility Reponse (271) Reject Reason Code field, select the reason if the inquiry was rejected.
    The next three fields must all be completed for any information to be saved in any of the fields.

42. In the Effective Date Of Medi-Cal Eligibility field, enter the effective date.

43. In the Eligibility Code field, select the code.
    An eligibility code of '000' will not enable Medi-Cal.

44. In the Aid Code field, enter the aid code, click the Search button, and select the corresponding entry.

45. In the Subscriber Client Index Number field, enter the number. Numbers entered in this field must:

• Contain exactly 9 characters.
• Start with '9'.
• Contain 7 numeric digits.
• End with an alpha character: 'A', 'C' through 'H', 'M', 'N', or 'S' through 'Y'.