Prior Medical PM
What should your begin dates reflect when PM is requested?
Three months prior to App date, first day of the month.
What is the number of the Pregnancy and Newborn job aid?
7.54
For Non-Deemed NB, should any records be left as pending, if you are making a final determination or sending the case to state for a final determination?
No. All records should be verified before a final determination can be made.
Reasonable Compatibility is what Tier in the Tier Process?
2- Interfaces and Resaonable Compatibility
What record do you enter to FTP a case?
Non-Compliance record
How would you process a PM request when there are no changes reported with no SE involved?
Work PM using current information provided.
Name 2 job aids that go over income.
1. Income Budgeting
2. Verifications
3. Income and Assests
4. Financial Income
5. Income Overview Powerpoint
6. Self Employment Powerpoint
When would we run cit/id verification for a Newborn?
Only when the Newborn is NON-DEEMED NB.
Scenario:
4/1/2023 PA reports $0.00 income, RC does not verify but pulled records are from 3rd quarter of 2022. How would you work this?
You could assume the PA is no longer working and verify the $0.00 income manually.
Which Reason drop down do you use when creating a Non-Compliance record?
Information Needed for Medical Eligibility
If PM is being requested for NB, but NB was not born until month of app, should the worker place the NB into pending for those PM months, deny those PM months and send a denial NOA?
No. We would not put the NB into pending for the PM months. This would be addressed in your case log stating PM is not needed due to NB coverage beginning at date of birth. The approval NOA must include the statement "You asked for prior medical coverage for ____ on your application. Coverage cannot be provided prior to the birth month. Coverage is denied for this reason for the months of _______"
Where, within the Team Pheonix General Channel, do you find the process to transfer a case to another department?
Tab at top of General Channel or the One-Stop-Shop
Do we run verifications on Self-Employment income?
No. Self-Employment is verified through tax return or SE form provided to the Clearinghouse by consumer. SE form can be filled out over the phone as well.
If KDOL comes back RC but TALX show a much higher amount of income or a more recent date, how would you determine which record to use to verify your income?
Research. A phone call will need to be placed to the consumer to determine which record is the most current representation of the HH's income. If you are not able to make contact with the consumer/employer, the case will need to be pended for income verification.
How many days does a consumer have to provide the requested information after their case is FTP'd to be considered an IROD?
12 days from denial or 45 days from date of application whichever gives the consumer more time.
FYI: There is a Data Calculator that will help calculate the IROD timeframe. This can be found in KanShare as well as our Team's general folder.
If P-Med is requested and the income doesn't verify but we have TALX income, do we add the pay checks from TALX to the income page, knowing that that is the only job the consumer has?
Yes.
Where do you find the step-by-step instructions only without the detailed explanation for why you are doing a certain task in KEES?
KEES User Manual
If SE is the only income reported, what steps do we take to verify the consumer's possible wages?
Create $0.00 wages record and run RC, to verify there is no other income from wages, as well as create a SE record with information provided on tax return or SE worksheet.
Why would an income record automatically verify after running RC if the 20% compatibility method or the $0.00 earnings RC Tests fail?
Reasonable Compatible Method shows Both Below.
If a case is pended for both income and verification of Cit/Id that are reporting US Cit and we only receive the requested income. Do we FTP the case or do we consider granting RO?
RO consideration.
If a PA reports a change in the P-Med income but the RC comes back as verified both below, do we still need to pend for Proof of Prior Med Income? At this time we do not know the changes.
Yes. If we do not know the specific changes in PM months we must pend for hard copy PM income.
What resource will you use for PM Simplification?
PC2021-11-01 PM Simplification
In general, if a change of income is reported when adding a DN, do we need to attempt to verify the income change?
Yes. If we are unable to verify the income change, we would notate in the case log that we attempted to verify the change but were unsuccessful and that the income change would need to be verified at time of review.
To attempt verification calls to the employer and/or consumer should be made. You can also review companion cases to get the needed information.
PA reports income but KDOL pulls $0.00, TALX pulls income in the 30-day date range, and RC is no, how would you go about verifying that income?
Because it is in the 30-day date range you would use the TALX amount and set frequency to monthly and manually set to verified Tier 3 TALX.
If PA is over income in current and PM income is requested and we are now imaged to the due date, and no new information has been provided, do we work the FTP for all months?
No. If information requested and not received was only to work the PM request, we would send to state to recommend an FTP in the PM months and denial due to excess income in current.