Member and Eligibility
This confirms the Member had active coverage when the PAR was received.
What is the eligibility check?
This is the request submitted before an HSS service can be reviewed.
What is a PAR?
Each authorization shell should be built for this many HSS service types.
What is one?
Intake uses this when basic paperwork is missing before Review.
What is an Administrative RFI?
If eligibility has not been checked, staff should do this.
What is Stop and verify eligibility?
Staff must make sure they are working in this correct TruCare profile.
What is the Member record?
The PAR should show the Member name, requested service, provider, dates of service and this.
What are units or amount?
This service code is used for Housing Transition Supports.
What is H0043?
Intake should not route to Review while this is still active.
What is an Administrative RFI?
A clearly duplicate active authorization should be documented and handled through this pathway if staff are unsure how to proceed.
What is escalation?
If eligibility has not been checked yet, Intake should stop before building this.
What is the authorization shell?
This is the ____ date and time the PAR was first received.
What is the PAR receipt date and time?
This service code is used for Housing-Related Deposit.
What is H0044?
Intake routes the case here when it is ready for decision _____.
What is Review?
Intake should document what was received and routed, but should not decide if the request is approved or this.
What is denied?
Staff document where they checked eligibility and the date they checked it.
What is the eligibility verification source and date?
If the PAR is missing something, Intake Staff should use this.
What is an Administrative RFI?
This service code is used for Housing Sustainment Services.
What is T2051?
Intake gets the case ready, but this team makes the approval or denial decision.
What is Review Staff?
If a duplicate or overlap is unclear, staff should do this.
What is escalate?
If staff cannot confirm the correct Member record, they should stop and do this.
What is escalate or ask for help?
Staff should not guess or change TruCare fields when the PAR does not match these.
What are supporting documents?
If a shell was built by mistake, staff should document the reason and do this.
What is void the shell?
If the issue requires criteria or sequencing review, it belongs with this team.
What is Review Staff?
Intake authority ends when the case is sent to this team.
What is Review Staff?