WAG 22-08-18

revised textIRDB gives medical providers immediate access to medical eligibility information not yet posted to the MMIS Recipient Eligibility Inquiry File. This is necessary because it takes 4 or 5 workdays for new or updated medical eligibility information entered by the FCRC or All Kids Unit to be posted to MMIS and to become accessible to providers through the Electronic Claims Processing (ECP) system. As a result, providers may deny medical services to a client because medical eligibility has not yet been posted to MMIS.

Updating the IRDB allows medical providers to verify a client's medical eligibility and submit claims for payment the same day the service is given. Staff may update the IRDB via the Interim Eligibility system (WinGrape Option F7) for an active medical benefits recipient who has an immediate medical need.

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new textNOTE: The entry of eligibility information into the IRDB does not authorize medical eligibility on MMIS. Complete all transactions in the usual manner to approve medical eligibility. The caseworker must process a transaction in IPACS or the Automated Spenddown System (ASDS) to meet spenddown.