Medical Eligibility Overview

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MEDICAL
IDENTIFICATION
CARD 

 SAMPLE CARD - Click here

Key to Medical ID Card

          Description

1. Address of CSO.

2. Date eligibility begins.

3. Date eligibility ends.

4. Medical Coverage Group (see chart after Key to Medical ID Card section).
   
   Patient Identification Code (PIC) Segments

5. First and middle initials (or a dash (-) if the middle initial is not known).

6. Six-digit birth date, consisting of numerals only (MMDDYY).

7. First five letters of the last name (and spaces if the name is fewer than five letters).

8. Tie breaker (an alpha or numeric character).
   
   Medical Coverage Information

9. Insurance carrier code – A four-character alphanumeric code (insurance carrier code) in this area indicates the private insurance plan information.

10. Medicare – Xs indicate the client has Medicare coverage.

11. HMO (Health Maintenance Organization) – Alpha code indicates enrollment in an MAA Healthy Options managed health care plan. (Managed health care plan is the same as health maintenance organization or HMO.) This area may also contain the legend PCCM (primary care case manager). The following ACES medical coverage groups, if not otherwise exempt, are required to enroll in Healthy Options: F01, F02, F03, F04, F05, F06, H01, P01, and P02.

12. Detox – Xs indicate eligibility for a 3-day alcohol or a 5-day drug detoxification  program.

13. Restrictions – Xs indicate the client is assigned to one physician and one pharmacist. The words "client on review" in Field 20 will also indicate restricted clients.

14. Hospice – Xs indicate the client has elected hospice care.

15. DD client - Xs indicate this person is a client of the DSHS Division of Developmental Disabilities.

16. Other – This area is not in use.

17. HIC shown here indicates that the client is on Medicare.

18. Name and address of client, head of household or guardian.

19. Medical program and scope of care indicators.

20. Other messages ( e.g., client on review, delayed certification, emergency hospital only).

21. Telephone number and name of PCCM or Healthy Options plan.

22. Local field office (3 digits) and ACES assistance unit # (9 digits).

23. Internal control numbers for DSHS use only.

24. Client’s signature – May be used to verify identity of client.

25. Client’s primary language.