Adult Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER NO. 24-02, New Validation Process for EPICS Referrals

DSS ADMINISTRATIVE LETTER NO. ECONOMIC INDEPENDENCE 08-2002

(Work First and Food Stamps)

DATE: APRIL 29, 2002

SUBJECT: NEW VALIDATION PROCESS FOR EPICS REFERRALS

DISTRIBUTION: COUNTY DIRECTORS OF SOCIAL SERVICES

PROGRAM INTEGRITY SUPERVISORS AND STAFF

INCOME MAINTENANCE SUPERVISORS

INCOME MAINTENANCE CASEWORKERS

I. Background

The purpose of this letter is to explain the new enhanced functionality of EPICS when a referral is created. In the past, the county dss used the override functionality when creating a referral due to the validation process within EPICS. The override function was necessary at the beginning of EPICS implementation to allow counties to enter referrals into EPICS on cases where data no longer existed in EIS. This situation should no longer occur. A new validation process has been created that improves the efficiency and integrity of the data that is keyed into EPICS when a referral is created.

II. EPICS Criteria for CREATING a New Referral

A. EPICS will no longer validate referrals based on the Individual ID number of the casehead. If EPICS cannot validate the Case ID and the Program Code for the Case ID in EIS or FSIS, EPICS will not allow the referral to be created.

B. For referrals with a Referral Type of R, P, and O, EPICS will not only validate against the Case ID number and the Program Code for that Case ID, but will also validate that the following conditions exist:

1. For Medicaid and NC Health Choice (NCHC) referrals, in order to validate the program code for the Case ID, EPICS must be able to validate that the program code in EIS for at least one Individual ID associated with the Case ID is also associated with the program code entered on the referral. If the program code and Case ID entered in EPICS cannot be validated in EIS, EPICS will not allow the referral to be created. (Note: EPICS will validate the first three characters of the program code against the program code in EIS for the Case ID, such as MAA, MIC or MQB.)

2. For Work First and AFDC referrals, in order to validate the program code for the Case ID, EPICS must be able to validate a check history segment in EIS associated with the Case ID. If EPICS cannot validate a check history segment in EIS for the Case ID, EPICS will not allow the referral to be created.

3. For Food Stamp referrals, a record must exist on either the FSIS Active Master File or the FSIS Inactive Master File. If EPICS cannot validate the Case ID in FSIS, EPICS will not allow the referral to be created.

C. For all front-end referrals, Referral Type F, EPICS will validate that a pending application is associated with the Case ID and the Program Code. If EPICS cannot validate the Case ID and Program Code for the pending application in EIS or FSIS, EPICS will not allow the referral to be created.

D. If EPICS will not allow a referral to be created, review the case record and EIS or FSIS, whichever is appropriate, to verify that the Case ID is correct and that the program code is correct for that Case ID.

1. If both the Case ID and Program Code are correct and you still cannot create the referral, contact EPICS Automation Support at 919-733-8938.

2. If an override is appropriate or policy issues need to be addressed, EPICS Automation Support will contact the appropriate DSS or DMA Program Integrity staff.

III. pROCEDURES FOR Requesting STATE PI STAFF Entry of a REFERRAL

A. EPICS Automation Support will contact the appropriate DSS or DMA Program Integrity staff once a county has verified that the Case ID and Program Code are correct for a referral that cannot be created in EPICS. The appropriate State Program Integrity Consultant will contact the county dss to discuss the problem. If it appears an override is appropriate, the county must forward a written request, along with supporting documentation, to the State office requesting an override to create the referral.

B. The following documentation must be provided to the State office when requesting an override of the validation process:

1. For Medicaid, NCHC, Work First, and AFDC referrals, an EIS screen print of the 8124 or 8125, the EIS CD, ID, IE and/or PC screens, or a case profile showing the Case ID and the Program Code.

2. For Food Stamp referrals, a DSS-8590 or a screen-print of the 8590 showing the Case ID and the Individual ID number.

3. In addition to the documentation, the request must include the following information:

• Referral type

• Name of Individual

• Individual ID number

• Program

• Referral date

• Case ID number

• County Case number

• Referring Person

• Referral Source Code

• Nature of Referral Code

• Allegation

4. All override requests must be on county dss letterhead and must be signed by a supervisor or the director. Fax all requests to the appropriate State office.

a. For Medicaid or NCHC referrals, fax the request to Brenda Porter or Pattie Woolard at 919-715-7706.

b. For AFDC, Work First, or Food Stamp referrals, fax the request to Shara Britt at 919-733-0645.

5. Once documentation has been provided, the state PI Consultant will create the referral in EPICS. The State office will notify the county DSS when the process is complete.

If you have any questions, please contact the appropriate Program Representative.

Nina M. Yeager, Director

Division of Medical Assistance

Pheon Beal, Director

Division of Social Services