MEDS
mEDI-CAL ELIGIBILITY DATA SYSTEM
START
Staff Development and Training
March 2025 Induction
lEARNING oBJECTIVES
[Learning is a Journey]
01.
Define MEDS/CDB and its purpose
05.
Explain SSN Validation and Reconciliation processes
02.
Transaction types that require CST/MTO action
06.
Identify a Burman hold & actions needed to release
03.
Understand MEDS/CDB transaction types and CalSAWS entries that translate them
07.
Identify and understand what creates MEDS alerts
04.
Describe the process for approvals, revisions, and corrections.
Materials
[Soft Copy]
- MEDS Training Workbook
- MEDS Log-On Step by Step
- SCD 1296
- CalSAWS Trigger Conditions
- MEDS Interactive Guide
- Presentation (available after class)
[hard Copy]
- MEDS Training Workbook
- MEDS QRG (Lavender)
- CalSAWS Trigger Conditions
What is MEDS/CDB?
[CDB = Central Data Base]
- Cash Assistance (CalWORKs)
- Medi-Cal
- General Assistance
- CalFresh
- SSI/SSP
- APTC (tracking purposes only)
+ MEDS/CDB Information Comes From Different Sources
[ways to Identify]
MEDS Identifiers
Identifying an individual in MEDS
[DATA iNDENTIFIERS]
Secondary
Tertiary
Primary
Data
Data
Data
County ID or CalHEERS Case Number
MEDS ID
CIN
OR CLIENT IDENTIFICTION NUMBER
This is the clients Social Security Number or Pseudo number
The County ID is a 14 digit alphanumeric sequence, while the CalHEERS case number is a 10 digit number
+INFO
+INFO
+INFO
Medi-Cal Card
[known as a Benefits identification Card or bic]
Auto Issued when:
- Eligibility approved for the first time
- Client’s Date of Birth is changed
- Returned due to an undeliverable address and MEDS later has a different address
Manually issued by EW in CalSAWS :
- Client calls requesting a new card to be mailed
+ INFO
MEDS Language of Communication
ict/Transfer cor
EW05
[Transaction types]
meds id/ssn change
EW10/FX10
- MEDS will only process ONE transaction type per person, per day
- See CalSAWS Trigger Conditions Handout
Update Client Info
EW12/FX30
EW20/FX20
Add/Activate/Approve
EW40
Terminate
Replacement BIC
EW45
[Exercise #1]
MEDS Exercise
[Trigger conditions - page 7]
CalSAWS Entries vs. MEDS Transaction Types
MEDS Updates & Processes
CalSAWS/CalHEERS MEDS/CDB interface
EW entries have a two-day turnaround (changes take 2 business days to show on MEDS)
Example: Changes made on Tuesday will show up in MEDS on Thursday
Combine MEDS records (EW11)
[EW Limitations]
CST/MTO Only Actions
Release Burman HOLD, if needed (EW35/40)
Issue Immediate Need and/or a temporary BIC card (EW15/45/55).
There are four actions which EW's cannot do through CalSAWS
Issue LOA (EW51)
Note: Submit an SCD 1296 to CST/MTO
Request for Online Transaction
- The second page has instructions for EW.
- EW must attach all appropriate screenshots. (see Clerical Handbook Ch 5 for process)
- EW Sup or EWIII must approve before submitting to CST/MTO)
[SCD 1296]
[Exercise #2]
MEDS Exercise
[Practice Filing out the SCD 1296 (pg 11]
Request for Online Transaction
[Immediate Need + Paper BIC Request]
- Immediate Need Request due to medical urgency
- Issue temporary paper BIC effective 05/01/2025 for P03. Aid code M1.
Request for Online Transaction
[Termination Request]
- Terminate Medi-Cal (T1 aid code) effective 06/30/2025 for P01 per client request (refer to page 22 of lavender handout for TERM Reason codes)
[Quick Glance]
MEDS Screens
MOPI
INQM
Example
Example
Always MatchMEDS
Authorizing benefits in CalSAWS
Adding a baby or a new person to an existing case
[Even if THE INFORMATION IS wrong!]
If the Name, SSN, Gender and/or DOB are different, MEDS/CDB will reject the transaction.
Wait _2_ days and verify that the record is active on MEDS/CDB before making any corrections or changes.
Approve using the info MEDS has (even if the information is incorrect)
Select the CIN from the existing MEDS record
CalSAWS & CalHEERS VS. MEDS
[information Must match meds]
- Identify and compare:
- Name
- SSN
- DOB
- County ID
- Address
- Eligibility Info (aid type, active etc)
- If the information does not match, records may be 'disconnected'
- This means that any updates or changes made from these systems will not reach MEDS
Individual File Clearance
[what is it?]
The process or act of checking CalSAWS, CalHEERS, and MEDS against the demographic information provided by the client.
Do NOT update CalSAWS prior to
checking all systems!!
This process is used to see if the client has an already existing record (whether active or inactive.)
That this process is done PRIOR to adding an individual to CalSAWS
+ INFO
SSN/NO SSN on MEDS
[It's important]
Before approving someone, ALWAYS check MEDS/CDB to ensure that the SSN is not being used by someone else!!!
If no record found (or record found belongs to your client), approve using the SSN
If SSN is being used by someone else (on an open or closed case), approve with the SSN field BLANK
SSN (MEDS-ID) CHANGES
Approve using the SSN currently on MEDS/CDB (Match MEDS even if incorrect)
BEFORE making changes or corrections to a client's SSN
Check MEDS to see if social security number is 'validated' or not
If SSN is NOT validated any change is allowable
Common Issues in MEDS
[See QRG PAGE 21 & 22 FOR SSN VALIDATION CODES]
1. DOB/Name/Gender is incorrect in MEDS, and the SSN has been validated 2. HOLDS (ex. Aged out client) 3. Address is not current (affects BIC requests) 4. Eligibility is not recorded
Is SSN Validated?
YES
Can we change client's DOB in CalSAWS?
NO
+ cORRECTING DOB FOR VALIDATED SSN
[MEDS UGSS CH 1]
MEDS Reconciliation Process
What is Reconciliation (Recon)?
- The county sends a "snapshot" of our information (CalSAWS) to DHCS
- A MEDS alert will be generated for EW's to correct any discrepancies identified.
Quarterly process run by DHCS to identify issues needing correction
* Recon months are March, June, Sept and Dec
State Info vs. County Info
- Identifies differences/ discrepancies
- Attempts to correct discrepancies
Recon compares current month information on MEDS/CDB to CalSAWS/CalHEERS
Burman Hold
[Burman v. Belshe]
MEDS-generated hold
MEDS record becomes "frozen"
MEDS is not taking CalSAWS' calls
A Burman Hold will occur because NO ACTION was taken on Daily or Monthly alerts that were previously generated. Places a hold (Burman) on records with unresolved discrepancies or places records in Edwards vs. Kizer aid code 38.
EW must fix the original problem prior to the HOLD being released.
meds alerts
[MEDS hANDBOOK CH 7]
What is a MEDS Alert?
[cewa - county eligibility worker alert]
- A CEWA is MEDS/CDB sending us a message about updates, changes or problems.
- Some alerts are informational only and do not require any action
- Other alerts require corrective action to be taken.
+ Alert Types
+ What triggers a MEDS Alert?
Where can I see the MEDS Alerts?
What to do with a MEDS alert?
CalSAWS
Is it MEDS or CDB?
(page 23)
MEDS Alerts need to be reviewed to determine the proper action to be taken
MEDS alerts can be found in two places...
High Priority & Performance MEDS Alerts List
MEDS
MEDS Interactive Guide
Confidentiality
EW can confirm identity of client if the client is in need of immediate medical services and provide BIC # verbally with clients consent
An interactive resource for all things MEDS
Accessing meds (refer to soft copy handout)
[Exercise #3]
Reading Real MEDS Screens
[reading the inqm, mopi, inq1, inqe and hiar screens]
Exercise #3
[Instructions]
After the time allowed, meet with your group to compare, and review answers for your designated scenarios. Designate a spokes person in your group and be prepared to tell the story of your case/family as we navigate your case in MEDS.
As you work individually and access the cases through MEDS by the SSN or case number provided, it is crucial to utilize the interactive MEDS guide, MEDS Login, Common Screen soft copy, and the Quick Reference Guide.
These resources will assist you in navigating and answering the questions on your scenarios.
Lorem ipsum
Lorem ipsum
Lorem ipsum
Very important not to enter fictitious information in this field
For individuals that do not have a Social Security Number
These identifiers will help identify a Psuedo number
- Note: Always check MEDS before activating benefits
Do NOT enter the SSN
SSN Erroneously Used by Another Person
- Leave SSN BLANK, or if SSN is already there, delete it before taking approval action
- Client will be activated on MEDS with a pseudo #
- Send client to SSA with MC 194, if necessary
- Refer to MEDS Coordinator via a GadWIN ticket
Including MOPI, are NOT to be given to clients or providers
MEDS Screens
Requires all Medi-Cal information be kept confidential
Federal Law
Under NO CIRCUMSTANCES should staff use MEDS data for purposes not directly related to the administration of the Medi-Cal Program
Staff Use
Reading the INQM Screen. Answer questions on page 13
Federal
CST/MTO
Counties/State
When MEDS is updated via EW request
Retirement or Disability income like RSDI or SSI/SSP
EDD (SDI/UIB)
Alerts can be found under the 'Admin Tools' in the Global Navigation bar and by selecting 'Alerts'
SCD 1296
An SCD 1296 is not initially needed to release a Burman Hold.
- The EW should correct the original problem that caused the HOLD
- If corrective action is taken to reconcile all applicable systems, the HOLD should fall off after the monthly MEDS renewal
- If the above steps have failed, (ie HOLD still appears after corrective action has been taken) then submit a 1296 to the office MTO
Alerts can be found under the 'Admin Tools' in the Global Navigation bar and by selecting 'Alerts'
Daily Alerts Created based on daily case updates, approvals, additions etc. Renewal/Monthly Alerts The renewal Monthly process establishes MEDS/CDB eligibility for the FUTURE calendar month. The MEDS/CDB Renewal process is run on approximately the 24th of each month. MEDS/CDB current month information becomes the first prior month of history after the Renewal process is run. Pending/future information is moved to the current mont
Eligibility Workers can view all worker alerts in the INQS screen by typing 'WA' in the option field and pressing enter on the number pad
- Creating duplicate/multiple MEDS records
- Discrepancies between CalSAWS, CalHEERS, and MEDS
- Duplicate issuance of benefits
- Taking over another client’s MEDS record
Index File Clearance Prevents:
Any time information is sent to MEDS/CDB for an individual (ex: address change, OHC, managed care, RSDI, eligibility changes, etc), if there is a discrepancy/conflicting information, that transaction may trigger a CEWA. The transaction may be sent by any entity. Regardless of who sent the info to MEDS/CDB, if an alert is generated, it is the eligibility worker’s responsibility to review all alerts and take any corrective action needed!!
[Instructions for validated ssn]
- Incorrect DOB Must Remain!
- Refer the client to SSA with MC194 (if applicable)
- Upon receipt of completed MC194, submit a GadWIN/Help desk ticket requesting the SSN-VER code lifted
- Once the SSN-VER code is lifted (replaced w/an asterisk *),
- CalSAWS is incorrect – enter correct DOB on Demographic window
- CalSAWS is correct – submit SCD 1296 to have DOB corrected on MEDS
if:
wHAT TO DO WITH A MEDS ALERT?
High Priority & Performance MEDS Alert List
Here is an example of important MEDS alerts that require immediate action from the Eligibility Worker. Some of these alerts will prevent any further MEDS updates, create a Burman Hold or could impact a clients eligibility. This list is a fraction of the types of MEDS alerts that can be received.
SCD 1296
An SCD 1296 is not initially needed to release a Burman Hold.
- The EW should correct the original problem that caused the HOLD
- If corrective action is taken to reconcile all applicable systems, the HOLD should fall off after the monthly MEDS renewal
- If the above steps have failed, (ie HOLD still appears after corrective action has been taken) then submit a 1296 to the office MTO
Medical Providers can see this information (MOPI)
wHAT TO DO WITH A MEDS ALERT?
High Priority & Performance MEDS Alert List
Here is an example of important MEDS alerts that require immediate action from the Eligibility Worker. Some of these alerts will prevent any further MEDS updates, create a Burman Hold or could impact a clients eligibility. This list is a fraction of the types of MEDS alerts that can be received.
Eligibility Workers can view all worker alerts in the INQS screen by typing 'WA' in the option field and pressing enter on the number pad
Immediate Need Paper Card
- For medical emergencies, ex: pregnant women and Minor Consent clients
- For ID purposes (until BIC arrives)
- Good for 30 days, from the issue date (has “Good Thru Date”)
- Is issued (by CST/MTO) in any district office
MEDS
Natasha
Created on March 13, 2025
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Women's Presentation
View
Vintage Photo Album
View
Geniaflix Presentation
View
Shadow Presentation
View
Newspaper Presentation
View
Memories Presentation
View
Zen Presentation
Explore all templates
Transcript
MEDS
mEDI-CAL ELIGIBILITY DATA SYSTEM
START
Staff Development and Training
March 2025 Induction
lEARNING oBJECTIVES
[Learning is a Journey]
01.
Define MEDS/CDB and its purpose
05.
Explain SSN Validation and Reconciliation processes
02.
Transaction types that require CST/MTO action
06.
Identify a Burman hold & actions needed to release
03.
Understand MEDS/CDB transaction types and CalSAWS entries that translate them
07.
Identify and understand what creates MEDS alerts
04.
Describe the process for approvals, revisions, and corrections.
Materials
[Soft Copy]
[hard Copy]
What is MEDS/CDB?
[CDB = Central Data Base]
+ MEDS/CDB Information Comes From Different Sources
[ways to Identify]
MEDS Identifiers
Identifying an individual in MEDS
[DATA iNDENTIFIERS]
Secondary
Tertiary
Primary
Data
Data
Data
County ID or CalHEERS Case Number
MEDS ID
CIN
OR CLIENT IDENTIFICTION NUMBER
This is the clients Social Security Number or Pseudo number
The County ID is a 14 digit alphanumeric sequence, while the CalHEERS case number is a 10 digit number
+INFO
+INFO
+INFO
Medi-Cal Card
[known as a Benefits identification Card or bic]
Auto Issued when:
- Eligibility approved for the first time
- Client’s Date of Birth is changed
- Returned due to an undeliverable address and MEDS later has a different address
Manually issued by EW in CalSAWS :+ INFO
MEDS Language of Communication
ict/Transfer cor
EW05
[Transaction types]
meds id/ssn change
EW10/FX10
Update Client Info
EW12/FX30
EW20/FX20
Add/Activate/Approve
EW40
Terminate
Replacement BIC
EW45
[Exercise #1]
MEDS Exercise
[Trigger conditions - page 7]
CalSAWS Entries vs. MEDS Transaction Types
MEDS Updates & Processes
CalSAWS/CalHEERS MEDS/CDB interface
EW entries have a two-day turnaround (changes take 2 business days to show on MEDS)
Example: Changes made on Tuesday will show up in MEDS on Thursday
Combine MEDS records (EW11)
[EW Limitations]
CST/MTO Only Actions
Release Burman HOLD, if needed (EW35/40)
Issue Immediate Need and/or a temporary BIC card (EW15/45/55).
There are four actions which EW's cannot do through CalSAWS
Issue LOA (EW51)
Note: Submit an SCD 1296 to CST/MTO
Request for Online Transaction
[SCD 1296]
[Exercise #2]
MEDS Exercise
[Practice Filing out the SCD 1296 (pg 11]
Request for Online Transaction
[Immediate Need + Paper BIC Request]
Request for Online Transaction
[Termination Request]
[Quick Glance]
MEDS Screens
MOPI
INQM
Example
Example
Always MatchMEDS
Authorizing benefits in CalSAWS
Adding a baby or a new person to an existing case
[Even if THE INFORMATION IS wrong!]
If the Name, SSN, Gender and/or DOB are different, MEDS/CDB will reject the transaction. Wait _2_ days and verify that the record is active on MEDS/CDB before making any corrections or changes.
Approve using the info MEDS has (even if the information is incorrect)
Select the CIN from the existing MEDS record
CalSAWS & CalHEERS VS. MEDS
[information Must match meds]
Individual File Clearance
[what is it?]
The process or act of checking CalSAWS, CalHEERS, and MEDS against the demographic information provided by the client.
Do NOT update CalSAWS prior to checking all systems!!
This process is used to see if the client has an already existing record (whether active or inactive.)
That this process is done PRIOR to adding an individual to CalSAWS
+ INFO
SSN/NO SSN on MEDS
[It's important]
Before approving someone, ALWAYS check MEDS/CDB to ensure that the SSN is not being used by someone else!!!
If no record found (or record found belongs to your client), approve using the SSN
If SSN is being used by someone else (on an open or closed case), approve with the SSN field BLANK
SSN (MEDS-ID) CHANGES
Approve using the SSN currently on MEDS/CDB (Match MEDS even if incorrect)
BEFORE making changes or corrections to a client's SSN
Check MEDS to see if social security number is 'validated' or not
If SSN is NOT validated any change is allowable
Common Issues in MEDS
[See QRG PAGE 21 & 22 FOR SSN VALIDATION CODES]
1. DOB/Name/Gender is incorrect in MEDS, and the SSN has been validated 2. HOLDS (ex. Aged out client) 3. Address is not current (affects BIC requests) 4. Eligibility is not recorded
Is SSN Validated?
YES
Can we change client's DOB in CalSAWS?
NO
+ cORRECTING DOB FOR VALIDATED SSN
[MEDS UGSS CH 1]
MEDS Reconciliation Process
What is Reconciliation (Recon)?
Quarterly process run by DHCS to identify issues needing correction
* Recon months are March, June, Sept and Dec
State Info vs. County Info
Recon compares current month information on MEDS/CDB to CalSAWS/CalHEERS
Burman Hold
[Burman v. Belshe]
MEDS-generated hold
MEDS record becomes "frozen"
MEDS is not taking CalSAWS' calls
A Burman Hold will occur because NO ACTION was taken on Daily or Monthly alerts that were previously generated. Places a hold (Burman) on records with unresolved discrepancies or places records in Edwards vs. Kizer aid code 38.
EW must fix the original problem prior to the HOLD being released.
meds alerts
[MEDS hANDBOOK CH 7]
What is a MEDS Alert?
[cewa - county eligibility worker alert]
+ Alert Types
+ What triggers a MEDS Alert?
Where can I see the MEDS Alerts?
What to do with a MEDS alert?
CalSAWS
Is it MEDS or CDB?
(page 23)
MEDS Alerts need to be reviewed to determine the proper action to be taken
MEDS alerts can be found in two places...
High Priority & Performance MEDS Alerts List
MEDS
MEDS Interactive Guide
Confidentiality
EW can confirm identity of client if the client is in need of immediate medical services and provide BIC # verbally with clients consent
An interactive resource for all things MEDS
Accessing meds (refer to soft copy handout)
[Exercise #3]
Reading Real MEDS Screens
[reading the inqm, mopi, inq1, inqe and hiar screens]
Exercise #3
[Instructions]
After the time allowed, meet with your group to compare, and review answers for your designated scenarios. Designate a spokes person in your group and be prepared to tell the story of your case/family as we navigate your case in MEDS.
As you work individually and access the cases through MEDS by the SSN or case number provided, it is crucial to utilize the interactive MEDS guide, MEDS Login, Common Screen soft copy, and the Quick Reference Guide.
These resources will assist you in navigating and answering the questions on your scenarios.
Lorem ipsum
Lorem ipsum
Lorem ipsum
Very important not to enter fictitious information in this field
For individuals that do not have a Social Security Number
These identifiers will help identify a Psuedo number
Do NOT enter the SSN
SSN Erroneously Used by Another Person
Including MOPI, are NOT to be given to clients or providers
MEDS Screens
Requires all Medi-Cal information be kept confidential
Federal Law
Under NO CIRCUMSTANCES should staff use MEDS data for purposes not directly related to the administration of the Medi-Cal Program
Staff Use
Reading the INQM Screen. Answer questions on page 13
Federal
CST/MTO
Counties/State
When MEDS is updated via EW request
Retirement or Disability income like RSDI or SSI/SSP
EDD (SDI/UIB)
Alerts can be found under the 'Admin Tools' in the Global Navigation bar and by selecting 'Alerts'
SCD 1296
An SCD 1296 is not initially needed to release a Burman Hold.
Alerts can be found under the 'Admin Tools' in the Global Navigation bar and by selecting 'Alerts'
Daily Alerts Created based on daily case updates, approvals, additions etc. Renewal/Monthly Alerts The renewal Monthly process establishes MEDS/CDB eligibility for the FUTURE calendar month. The MEDS/CDB Renewal process is run on approximately the 24th of each month. MEDS/CDB current month information becomes the first prior month of history after the Renewal process is run. Pending/future information is moved to the current mont
Eligibility Workers can view all worker alerts in the INQS screen by typing 'WA' in the option field and pressing enter on the number pad
Index File Clearance Prevents:
Any time information is sent to MEDS/CDB for an individual (ex: address change, OHC, managed care, RSDI, eligibility changes, etc), if there is a discrepancy/conflicting information, that transaction may trigger a CEWA. The transaction may be sent by any entity. Regardless of who sent the info to MEDS/CDB, if an alert is generated, it is the eligibility worker’s responsibility to review all alerts and take any corrective action needed!!
[Instructions for validated ssn]
if:
wHAT TO DO WITH A MEDS ALERT?
High Priority & Performance MEDS Alert List
Here is an example of important MEDS alerts that require immediate action from the Eligibility Worker. Some of these alerts will prevent any further MEDS updates, create a Burman Hold or could impact a clients eligibility. This list is a fraction of the types of MEDS alerts that can be received.
SCD 1296
An SCD 1296 is not initially needed to release a Burman Hold.
Medical Providers can see this information (MOPI)
wHAT TO DO WITH A MEDS ALERT?
High Priority & Performance MEDS Alert List
Here is an example of important MEDS alerts that require immediate action from the Eligibility Worker. Some of these alerts will prevent any further MEDS updates, create a Burman Hold or could impact a clients eligibility. This list is a fraction of the types of MEDS alerts that can be received.
Eligibility Workers can view all worker alerts in the INQS screen by typing 'WA' in the option field and pressing enter on the number pad
Immediate Need Paper Card