***DRAFT***
September 3, 1998
Client Eligibility
Data Elements
II. CLIENT ELIGIBILITY DATA ELEMENTS [Eligibility criteria would vary by contract]
Item |
FN-11 |
Source |
Other |
¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ® |
|
# |
Data Element |
Document |
Name |
Definition |
Workgroup Comments |
1 |
Payors | Workgroup |
Medicaid Medicare Third Party Health Self-pay |
Multiple records for multiple membership? | |
| If managed care: | |||||
2 |
Eligibility Status | EE #66 FN-10 p.153 |
Client Eligibility; Eligibility Determination | Client’s eligibility status for payment of services. Eligible and receiving payments Eligible but not receiving payments Potentially eligible (not yet determined) Determined to be ineligible Not applicable |
Will be based on other variables, e.g., income and number in household |
3 |
Enrollment Begin Date | EE #68, 70, 73 |
Effective Date of Coverage; Date Enrollment Begins | The defined date a covered person becomes eligible for benefits under an existing contract (mm/dd/yyyy) | |
4 |
Enrollment Ending Date | EE #69, 72 |
Date Enrollment Ends | The defined date on which benefits for a covered individual are terminated (mm/dd/yyyy) | |
5 |
Disenrollment Reasons | Workgroup |
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