0815.080.00 Entering a Vendor Case Into IMU5

There are several entries into IMU5 which apply specifically to vendor cases. This section provides an overview regarding fields and entries unique to vendor cases. For complete IMU5 instructions, refer to the forms manual.

FIELD NUMBER ENTRY REQUIRED
Field 2 Enter the vendor facility name.
Field 14 Enter the vendor facility name.
Field 15B Enter the vendor facility number. (The number can be obtained from the Medicaid provider List Screen (MPRT).
Field 16 Enter date eligible for vendor coverage.
Field 22D

Enter the date and amount of the vendor surplus. If surplus amounts vary, enter the date and amount for each surplus.
EXAMPLE: Ms. Y is approved for vendor on December 28. The effective date of her vendor surplus is December 1. Her surplus amount for December is $350.00. Her surplus for January will change to $382.00 because her Social Security income will increase. In this situation, two entries are required in field 22D.
Field 13E Enter the effective date for current Medicaid level of care.
Field 13G Enter the level of care code:
  • N - Nursing Facility
  • K - Institution for the Mentally Retarded
  • D - Mental Health Center
  • L - Community Spouse or Dependent receiving an allotment from the claimant.
Field 13W An entry is required in this field for all individuals with an L level of care.
  • Y - Utility Standard used
  • N - No utility expense
  • T - Telephone standard used
  • D - Minor or dependent living with community spouse
Field 13V An entry is required in this field for all individuals with an L level of care. Enter the amount of the individual's gross income.
Field 13X An entry is required in this field for all persons with an L level of care. This code controls how a case is handled in automatic mass adjustments when standards change.
  • Code L - Claimant is making an amount less than the maximum available to the community spouse.
  • Code H - A hearing officer has set a higher allotment than the maximum allowed.
  • Code Y - The claimant wishes to make all possible income available to the community spouse. The community spouse's total maintenance standard is greater than the Maximum Maintenance Standard.
  • Code N - The claimant wishes to make all possible income available to the community spouse. The community spouse's total maintenance standard is equal to or less than the Maximum Maintenance Standard.
Field 13Y Enter the total shelter expense figure from line 5 of the IM-30E.