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medicaid eligibility and patient liability determinations - Kymmis.com

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Active member’s with a new LOC<br />

For active members in a covered group who<br />

are later identified as needing Nursing Facility<br />

Level of Care (LOC) by the Peer Review<br />

Organization (PRO). DCBS receives<br />

notification that a LOC has been met (the<br />

active member was admitted to a NF or<br />

Waiver) <strong>and</strong> <strong>com</strong>pletes the needed tasks to<br />

determine LTC <strong>eligibility</strong>. Once <strong>com</strong>pleted<br />

the <strong>eligibility</strong> system generates a MAP-552.

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