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BAM 301 6 of 14 AP CASE READING GUIDE BPB 2022-001 1-1-2022

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

• Are the begin and end dates for the patient-pay amount correct? If this is an active deductible case, are the begin and end dates for the deductible amount correct? 7) Pursuit of Benefits BEM 125, 126, 129, 131, 164, 165, 255, 256, 257, BAM 110, 220, 270 • Has the group pursued all potential benefits as required? (RSDI, workers compensation, UCB, etc.) • If the case indicates another responsible party (absent parent/spouse, insurance company, worker's compensation etc.) has a DCH-1354A been completed? If yes, is Bridges coded for Third Party Liability? • At FIP closure or denial, was eligibility for other MA programs (TMA, Special N/Support, Healthy Kids and the Newborn Category, etc.) explored? • If the case contains a pregnant woman or a child, was eligibility under the Healthy Kids categories properly determined? • If the case contains a pregnant woman and she is not eligible for Healthy Kids For Pregnant Women, (BEM 125) was eligibility under Group 2 Pregnant Women (BEM 126) properly determined? • For aged, blind and disabled MA applicants or recipients, was eligibility for QMB, limited QMB and Extended Care properly determined? • If the case contains a disabled, employed person, was eligibility for Freedom to Work properly determined?

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Page 6

Official source

BAM 301 6 of 14 AP CASE READING GUIDE BPB 2022-001 1-1-2022

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

• Are the begin and end dates for the patient-pay amount correct? If this is an active deductible case, are the begin and end dates for the deductible amount correct? 7) Pursuit of Benefits BEM 125, 126, 129, 131, 164, 165, 255, 256, 257, BAM 110, 220, 270 • Has the group pursued all potential benefits as required? (RSDI, workers compensation, UCB, etc.) • If the case indicates another responsible party (absent parent/spouse, insurance company, worker's compensation etc.) has a DCH-1354A been completed? If yes, is Bridges coded for Third Party Liability? • At FIP closure or denial, was eligibility for other MA programs (TMA, Special N/Support, Healthy Kids and the Newborn Category, etc.) explored? • If the case contains a pregnant woman or a child, was eligibility under the Healthy Kids categories properly determined? • If the case contains a pregnant woman and she is not eligible for Healthy Kids For Pregnant Women, (BEM 125) was eligibility under Group 2 Pregnant Women (BEM 126) properly determined? • For aged, blind and disabled MA applicants or recipients, was eligibility for QMB, limited QMB and Extended Care properly determined? • If the case contains a disabled, employed person, was eligibility for Freedom to Work properly determined?