SSI-DCP: UpdatedHow Do I Submit a Request for Formula?

Healthcare professional’s prescription/ statement should indicate how many cans of supplemental formula are recommended per day as well as the reason the professional is recommending the supplemental formula. Multiply number by 30, and then divide by number of cans in a case to determine how many cases are needed monthly. Always round up.

Example: Child’s script indicates 5 cans daily for 30 days (month). 5 x 30 = 150 cans divided by number in case Ensure Plus (24) = 6.25 or 7 cases.

Cans per case by brand
Brand Cans Per Case
Boost (lsocal) 24
Pediasure w/Fiber 24
Ensure Plus 24
  1. In IMS, enter ausn <space> case number
    In IMS - 'ausn D000001
  2. Enter the child’s person number from the CM screen, then  enter S, next to Formula for the AUSNF screen (IMS)
    S is displayed next to 'Formula (F)'
  3. Enter the following information on the AUSNF screen:
    • Brand of Formula;
    • Cans per Day – two digit entry (lead with a zero, if needed)
    • Mon Tot (Monthly Total) Using Calculation Method – three digit entry (lead with zeros, if needed)
    • Press Enter

    Action type will display as A.
    Brand of Formula = Ensure Plus, CANS DAY = 05, MON TOT = 006
    This process puts the authorization on the EKL screen.
    SSI-DCP-EKL view.

    The Action type will display as “O” (Open) once approval has been granted by HRMS staff.

The ordering process that follows is outlined in policy 340:15-3-1. Instuctions to Staff #7.

Refer to article SSI-DCP:UPDATE to Formula Request.

For additional questions regarding SSI-DCP; contact Charla Hursh.

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