Liability Deviations
What is a deviation?
A deduction for an incurred medical expense not covered by Medicaid and not subject to payment by Medicare or other insurance.
What is a FIAT used for?
To determine eligibility for any program for a past month of a month for which the system did not determine eligibility. (When adding a person to the assistance group who was eligible for that assistance.)
How do you ensure a fiat has not already been done
Search the eligibility system and benefit issuance history
SNAP and TANF benefits restored at the same benefit level when the appellant has filed a timely appeal is what?
Continued Benefits
An under issuance is only used for?
Only the months Prior to the current month
What is a liability?
The amount which Medicaid will not pay to the Long Term Care Facility.
When would you use override?
When correcting benefits for any program for any months that have not been authorized.
How many FIAT pages are in IEDSS?
2 FIAT pages in IEDSS
What is the eligibility correction that issues auxiliary benefits in IEDSS?
Manual Issuance
Who creates an over/under issuance referral for Benefit Recovery?
ES, SEC, or SEM
What needs to be included with the deviation request?
Provider generated bill, Date of service, Type of Service, and Amount recipient owes after any third party has paid.
When is a manual issuance appropriate?
To correct current benefits for SNAP/TANF. Policy uses the term auxiliary (may also hear it referred to as aux) for manual issuances and IEDSS uses the term manual issuances.
. Where can the Override function be found in IEDSS?
On the Eligibility Determination Results in the left navigation bar.
This is used when the benefit was under-issued due to agency error.
Restoration
What page in IEDSS do you access to create a referral for a claim or under issuance
Referral Details page
What is a CUMED?
A process of manually reducing the liability amount. Allows the SEC to make non-adverse corrections to the liability amount for months where the system is no longer calculating budgets.
Who can create Fiats, Manual Issuances, Overrides, and Under/Over issuance referrals for Benefit Recovery?
Eligibility Specialists(ES), State Eligibility Consultants (SEC), or State Eligibility Managers (SEM)
Liability Overrides are the same as an Override. T/F
False,
A liability is the amount which Medicaid will not pay to the Long Term Care Facility.
An Override is used to correct eligibility.
Supplemental Issuance Type is used by what team?
Benefit Recovery
An over issuance is used for?
An over issuance is used for both the current and prior months
What must an ES determine before requesting a CUMED?
If the system is still calculating budgets for the first month of the deviation period.
The same SEC/SEM that creates a manual correction is the same SEC/SEM to authorize it. (T/F)
False, a different SEC/SEM must authorize it.
Overrides are able to be completed for what categories of assistance?
All categories of assistance are able to be completed. SNAP, TANF and Health Coverage
What type of worker can approve a Manual Issuance?
Only an SEC or SEM
Under issuance claims are a result of what?
An agency error in timely processing of a reported change or incorrect data entry.