The Third Party Liability-Other Health Insurance Detail page is where information is captured for a consumer’s third party private insurance. Information entered on this page is sent through an Interface to the MMIS.
Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Open the financial data pages by clicking on the + beside Financial from Task Navigation. Select Other Health Insurance from Task Navigation. The Third Party Liability - Other Health Insurance List page displays.
Click the Add button. The Third Party Liability - Other Health Insurance Detail page displays.
Select the Beneficiary(ies) from the multi-select menu of case members.
Select the Health Coverage type from the drop-down menu.
Enter the Start Date for the record using the <mm/dd/yyyy> format or click the calendar icon.
NOTE: If the policy is ending during application or prior Medical months an End Date should be entered. If the policy is still active no End Date needs entered.
Under Health Insurance Information, enter the following information:
Health Insurance Company Name
Policy Number
Group Number
NOTE: The Policy Number field is required to be entered to navigate away from the page. If you don’t have the policy number information, enter UNKNOWN. Entering "bad data" in the Policy Number field causes errors on the interface file. If the "bad data" is mapped from the SSP or Worker Portal, update it to UNKNOWN.
Choose Type of Coverage from drop-down menu.
In the Policy Holder Information section enter the following information:
Policy Holder’s Name
Policy Holder’s SSN
Select Who is Covered from the drop-down menu of case members
NOTE: If the user multi-selects the Beneficiary that will create the needed records on the Third Party Liability-Other Health Insurance List page, it is not necessary to go through the process and select each individual from the “Who is Covered?” drop-down menu.
In the Name field, type the name of the Employer, Union, Group, Organization, or School associated with the insurance plan, if applicable
Enter the EIN (Employer Identification Number)
Enter the Local or Group Number
Select Yes or No from the Is this a Union drop-down menu
Enter Address information: street, city, state, zip
Enter the Telephone number
Under the Access to Health Insurance section, select the Yes/No options for the following questions:
Member has access to employer sponsored health insurance – Indicating Yes to this question will have NO impact on EDBC results.
Member has access to State Health Insurance – Indicating Yes to this question results in a failing CHIP budget when EDBC is run.
Member has health insurance that has ended in the past 3 months – Indicating Yes to this question will have NO impact on EDBC results.
Select Verified from the drop-down menu.
Click the Save and Return button on the Third Party Liability - Other Health Insurance Detail page to retain the data.