Who Does What?
This team member completes Intake: confirms the request is complete and ready for Review.
What is Intake Staff?
Services that help Members obtain or keep housing (no rent or room & board).
What is Housing Supports & Services (HSS)?
A document is uploaded but not linked. Should staff keep going?
STOP - documents must be uploaded and linked before moving forward.
This is the system of record for HSS authorizations.
What is TruCare: system of record for HSS authorization activity?
This HSS service may help with a one-time housing deposit.
What is Housing-Related Deposit: one-time support for approved move-in costs (not rent/ongoing costs)?
This team member completes Review: applies criteria and makes the approval, denial, or RFI decision.
What is Review Staff?
A request sent for Plan review before services begin.
What is Prior Authorization Request (PAR)?
The Member record is correct and eligibility is verified. Should staff keep going?
KEEP GOING - Intake checks are complete, ready to route to Review.
This system may help with referrals, but not authorization decisions.
What is FindHelp: used for referrals only, not authorization decisions?
This deposit benefit is usually allowed how many times?
What is once per Member lifetime (unless an exception applies)?
This team member sends an Administrative RFI when basic information is missing.
What is Intake Staff?
Used when information is missing or unclear/asking for more information.
What is Request for Information (RFI)?
There is an active RFI. Should staff make a decision?
STOP - do not make a decision while an RFI is active.
This is where staff build the authorization request in TruCare based off of the recieved PAR request.
What is TruCare authorization shell?
This check looks to see if the Member already used the deposit benefit.
What is Deposit utilization check: confirms if the benefit was already used?
This team member decides: approve, deny, or send a Review RFI if more information is needed.
What is Review Staff?
This occurs when the request cannot move forward until basic information is complete.
What is Administrative RFI?
Review has not taken ownership yet. Should Review start?
STOP - Review shouldn't begin review until they have updated the Ownership field to their name.
This is where service dates, units, amount, and code are entered.
What is Line Item?
Deposit approval means the deposit was already paid or used. True or false?
FALSE - approval allows payment, it does not mean payment has already been made.
This is used when the correct pathway is unclear or needs higher-level review.
What is Escalation?
A review step that tells the story of the decision - what was reviewed, what the rules require, and why the request was approved or denied.
What is Determination Rationale?
The notice does not match the decision. Should staff send it?
STOP - notice must match the decision and rationale before sending.
This is sent when a decision is made and the Member must be told.
What is Notice: sent to communicate the decision and appeal rights?
A deposit is approved today, but no one has proof yet that it was paid. Should staff mark the deposit as used?
NO - deposit is only “used” after payment is confirmed and documented.