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Correspondence |
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M011 |
General Correspondence (Not to be used for adverse action) |
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Approvals |
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M101 |
Approval 1st Month - Deny 2nd Month |
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M102 |
Initial Medical Application Approval |
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M103 |
Retroactive Medical Approval |
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M104 |
LSC Approval/Medical Institution |
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M105 |
State LSC Approval |
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M106 |
Initial Approval of PW ME Application |
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M107 |
Initial Approval of AF-related (Adult required to cooperate w/CS) |
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M110 |
Illegal Alien - Emergency Medical Services Approval |
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M152 |
Initial QMB Application Approval |
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M162 |
Initial SLMB Application Approval |
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M163 |
Initial SLMB #2 Application Approval |
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M173 |
Approval PDA |
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M180 |
Approval for Waivered Services (HCBS/DD) |
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M181 |
Approval for Children's Mental Health Waiver |
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M182 |
Approval Pregnant By Choice |
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M185 |
TB Related Services (TBS) Application Approval |
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M186 |
Hospice Care Services (HSPS) Application Approval |
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M187 |
Medicaid Approval Medical Institution/No Room and Board |
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M188 |
Initial Approval - EID Medical Program |
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M189 |
Medical Renewal Approval |
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M190 |
Foster Child Approval |
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M191 |
Aging Out Foster Care Approval |
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Denials |
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M201 |
Failure to Provide Information |
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M202 |
Failed to Complete Application Process |
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M204 |
Verification of Residence |
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M205 |
Citizenship Status |
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M207 |
Excess Income - Over Income |
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M208 |
Excess Resources |
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M209 |
Deny 1st Month - Approved 2nd Month |
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M210 |
Excess Income - Family & Children's Programs |
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M211 |
Lack of Spouse’s Information |
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M212 |
Failure to Use All Income Sources |
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M213 |
Denial - Other Reasons |
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M214 |
Application Withdrawn |
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M215 |
Loss of Contact |
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M220 |
Receiving Assistance in Another State |
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M221 |
SLSC/SHP Denial |
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M222 |
30 Day Institutionalization Not Met |
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M224 |
LSC Medical Necessity |
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M272 |
Denial/Closure (PDA) |
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M273 |
Denial/Transfer of Resources |
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M288 |
Denial - EID Medical Program |
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Pended |
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M301 |
Additional Information Required - Pend |
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M302 |
Pended - HCBS Approval of Plan of Care |
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M303 |
Pended - Other Reasons |
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M304 |
Pended – Developmentally Disabled |
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Closures |
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M401 |
Failure to Provide Information |
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M402 |
Failure to Complete Review |
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M404 |
Verification of Residence |
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M405 |
SLSC Termination - No Income Trust Established |
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M407 |
Excess Income |
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M408 |
Excess Resources |
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M410 |
Excess Income - Family & Children's Programs |
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M412 |
Failure to Use Prior Resource |
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M413 |
Other Reasons |
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M414 |
Closure - Client Request |
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M416 |
Closure - Post Partum |
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M417 |
Incomplete Change Report |
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M419 |
Death of Recipient |
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M420 |
Family Care (12M) Closure |
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M472 |
Closure of PDA |
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M473 |
Closure/Transfer of Resources |
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M488 |
Closure - EID Medical Program |
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M489 |
Closure – Due to Age 19 |
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M490 |
Closure – Postpartum |
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M491 |
Closure – Foster Child |
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M492 |
Closure – Aging Out Foster Care |
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M493 |
Closure – Pregnant By Choice |
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Changes |
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M701 |
Decrease in Patient Contribution |
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M702 |
Increase in Patient Contribution - Income |
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M703 |
LSC/SLSC/SHP Ongoing-One Month Ineligible |
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M788 |
Premium Change - EID Medical Program |
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Miscellaneous |
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M801 |
Medical Periodic Review (PDA, Aged, Blind and Disabled) |
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M820 |
Family Care (12M) Medical |
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M821 |
Family Care (4M) Medical |
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M829 |
Family Care (AF-re)/Excess Income (4/M/12M) |
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M830 |
Have You Had Your Baby? |
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Overpayments |
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M902 |
Possible Overpayments |
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M903 |
First Notice of Medical Overpayment |
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M904 |
Second Notice of Medical Overpayment |
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M905 |
Notice of Disqualification or Judgment |
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M908 |
Past Due Payment Notice |
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M910 |
Computer Match Overpayment |
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M930 |
Receipt of Payment |
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M931 |
Payment in Full |
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M953 |
Billing Statement |
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Automatic Notices |
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X012 |
Family Care (12M) Closure |
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SSI Medicaid |
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X501 |
SSI Medicaid Closure |
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X502 |
SSI Medicaid Approval |