Family and Children's Medicaid MA-3515 AUTOMATED INQUIRY AND MATCH PROCEDURES

III. MATCHES REQUIRED BY IEVS

A. ESC/UI On-Line Inquiry

1. The Employment Security Commission (ESC) inquiry provides information on an individual’s earnings and Unemployment Insurance (UI) benefits.

2. Do the on-line inquiry:

a. At application for all a.u. members. A.U. members will be included in the quarterly match at redetermination.

b. When an a.u. member reports loss of employment,

c. To verify amount and duration of UI benefits. Flag the case to check again when benefits are scheduled to terminate.

3. It is recommended that an on-line inquiry be done at application and review for non-a.u. financially responsible individuals who have provided their SSN and agree to the match.

4. Do an inquiry using all SSN’s reported on each member of the a.u. and for b.u. members whose SSN’s are available and who have agreed to the match, except for individuals under the age of 16 and individuals who are residents in a nursing facility, to discover leads to possible wages, previous work history, potential eligibility for UI and potential Third Party Liability (TPL).

a. If the inquiry shows the a.u./b.u. member has wages or UI, compare the place and period of employment or amount of UI shown to the information reported by the a/r. Document your findings on the application/review form.

b. Follow up all leads by discussing them with the a/r. If the a/r is potentially eligible for UI, refer him to ESC to apply. If wages are shown for an a.u./b.u. member, contact any employer in the six months prior to the month of application or review interview for employment status and available TPL. Document your findings on the application/review form.

c. If the record shows that employment and availability of TPL has already been verified, document on the application/review form that the ESC inquiry was done and take no further action.

d. If the wages, UI, or TPL were previously unreported, document the record to substantiate that the inquiry was done and to reflect the results of the match.

(III.)

B. ESC Quarterly Match

1. The quarterly SSN/ESC & UIB Match Reports are produced through a computer match of the ESC/UI and eligibility files. EIS generates printed reports within one month following the end of the previous quarter. Quarterly reports are also available on NCXPTR (DHRVES EIS SSN/ESC & UIB MATCH) and are available the second week of each quarter for the previous quarter’s information. Due to ESC procedures for compiling data, there is a quarter lag in the information received. The match is produced in addition to the on-line inquiry to keep the agency informed of changes between application and review and from review to review.

2. Within 45 days from the date on the match report, complete the appropriate actions outlined below:

a. Upon receipt of the printed report and/or NCXPTR quarterly update, check each match against your caseload.

b. If the report shows reported employment or UI for the a.u. member, compare the place and period of employment or UI to that in the record.

c. If the record shows the employment or UI has already been verified, document the record that the report was checked and take no further action.

d. If the record shows that employment or UI was not reported, contact the recipient to determine possibility of overpayment, underpayment or potential fraud. Contact the employer to verify employment and available TPL.

e. Document the record to substantiate that the Quarterly ESC Report was checked and the results of the match.

C. BENDEX

1. The BENDEX system is a monthly computer match by SSN’s between the public assistance recipient files and SSA records. All recipients with SSN’s in EIS will be included in the match.

2. Do an on-line inquiry at application on all a.u. members and b.u. members who have provided their SSN’s and agreed to the match. Complete a check using all SSN’s reported by the client. Refer to the EIS Manual, Section 1104, for instructions and additional information.

(III.C.)

3. If a record is found, verify the a.u./b.u. member’s SSN and/or entitlement amount and document the application/review form. To verify information on the BENDEX is correct, use the SOLQ/TPQY procedures outlined in the EIS Manual, Section 1107. Contact SSA (SSA District Offices) to resolve conflicts between a/r’s allegations and the information shown on BENDEX/SDX/SOLQ/TPQY.

4. In addition to the on-line BENDEX, the computer prints an individual BENDEX information sheet identifying the a.u. member and the current status of his SSA benefits. You will only receive a BENDEX sheet on an a.u. member when:

a. He first receives Social Security,

b. He becomes entitled to an increase or decrease in benefits,

c. There is a change in hospital benefits,

d. He is entitled to supplemental Medicare Part B insurance,

e. There is any other change in SSA’s Master Beneficiary Records (MBR).

5. Because the BENDEX sheets indicate a change in the a.u. member’s SSA data, the worker must compare this information with the case record each time a BENDEX sheet is received. Any necessary action must be taken within 45 days of the date on the BENDEX sheet, or no later than the next case action or redetermination, whichever is earlier.

a. If the record indicates this information has already been reported and verified, document the record and take no further action.

b. If the changes were previously unreported, document the record to substantiate that the BENDEX was checked and to reflect the results of the match.

D. SDX

1. This on-line match provides detailed information about benefits received by SSI recipients. In addition, EIS generates SDX Information Sheets daily to provide current information on changes of address, or other changes in situation. EIS generates SDX Information Sheets for SA, HSF, and also MAABD cases if the individual has a long term care living arrangement code and is SSI.

2. In addition to the on-line SDX, EIS generates an individual SDX information sheet identifying the recipient and the current status of his SSI benefits. You will only receive a SDX sheet when:

a. Supplemental Security Income is first approved; or

(III.D.2.)

b. Certain information has changed in his SSI record. Changes that will cause an SDX sheet to be produced are:

(1) Payee name and address, including a move out of state

(2) Date of birth

(3) Living arrangement

(4) Marital status

(5) Title II claim number

(6) SSI gross amount

(7) SSI assistance amount

(8) Pay status

(9) Death date

(10) Denial code

(11) PASS (Plan for Achieving Self Support)

(12) Resource code-house

(13) Resource code-income producing property

(14) Resource code-life insurance

(15) Resource code-vehicle

(16) Resource code-other

(17) Countable earned income

(18) Countable unearned income

(19) Unearned income information:

(a) Type

(b) Start

(c) Stop

(d) Amount

(e) Frequency

(f) Claim/ID number

(20) Transaction Record is ´5´ (Individual moved out of state)

Note: The changed data element will be preceded by an asterisk (*).

3. Do an on-line inquiry at application for all a.u. members and for b.u. members whose SSN’s are available and who have agreed to the match. Use all SSNs reported. Refer to EIS Manual, Section 1105 for instructions and additional information.

a. For M-AABD cases, the on-line inquiry must be done for all a.u. members and for b.u. members whose SSNs are available and who agree to the match.

b. For M-AF and related cases, the inquiry must be done if there is an aged, blind, or disabled individual in the b.u.

(III.D.)

4. If a record is found, verify the a.u./b.u. member’s SSN and/or entitlement amount and document the application/review form. If additional information is needed, and information cannot be found by using the SDX or Bendex, use the SOLQ or TPQY system. SOLQ/TPQY procedures are outlined in the EIS Manual, Section 1107. Use the SSA-1610, Public Assistance Agency Information Request, (Attachment 2), to resolve conflicts between the client/representative’s allegations and the information shown on BENDEX/SDX/SOLQ/TPQY.

5. The on-line SDX is updated quarterly for all SSI recipients and also updated daily with changes received from the daily files.

6. Because the SDX sheets indicate a change in the a.u. member’s SSI data, the worker must compare this information with the case record each time an SDX sheet is received. Take any necessary action within 45 days of receipt of the SDX sheet, or no later than the next case action or redetermination, whichever is earlier.

E. SOLQ (State Online Query)

SOLQ is a method of verifying RSDI and SSI benefits for applicants and recipients of Medicaid. This inquiry reduces the need to refer a/r’s to the local SSA offices to obtain benefit verification. SOLQ procedures are outlined in MA-3515, Automated SOLQ Procedures, and EIS Manual, Section 1107.

F. TPQY (Third Party Query)

The TPQY system is an alternate method of verifying RSDI and SSI benefits. TPQY may be used when the SOLQ system is unavailable or when 40 quarters information for aliens is needed. SSA returns information within 24 to 48 hours. TPQY procedures are outlined in MA-3515, Automated SOLQ Procedures and EIS Manual, Section 1107.

G. BEER (Beneficiary Earnings Exchange Report)

1. This match identifies recipients who have earnings reported to SSA. This match is run on the third work day of each month.

2. Since BEER data is obtained by Social Security from the IRS, the data must be safeguarded. A central person in the county must receive the BEER report. This person must secure all BEER data in a locked file for retention purposes. This person is to distribute data to IMC’s. The IMC’s must take any necessary action within 45 days and return the report to the central person as per instructions in the DMA Administrative Letter 16-02 regarding the Security of Internal Revenue Service and Social Security Administration information.

(III.G.)

3. Within 45 days from the date on the BEER report, or no later than the next case action or redetermination, whichever is earlier, complete the appropriate actions for income involving self-employment earnings and pensions, outlined below:

a. Upon receipt of the BEER report, check each match against your caseload.

b. If the record shows that this information has already been verified, document the record that the report was checked and return the report to the central person. Take no further action.

c. If the record shows the earnings were not reported, contact the recipient to determine the possibility of overpayment, underpayment or potential fraud. Contact the employer to verify employment and available TPL.

d. Document the record to substantiate that the BEER report was checked and the results of the match.

H. IRS Monthly Match

1. The IRS match is conducted monthly in each aid program/category for pending applicants and newly approved recipients with a valid social security number. (See I. below for information on the yearly match for ongoing recipients.) Monthly “Financial Resource Report” (FRR) match information is mailed to the counties in a hot pink envelope marked confidential. If the a/r’s SSN is not matched, no information is provided on the report. The annual FRR run is normally in July or August of each year.

2. IRS safeguards require that a central person in the county receive IRS data. This person must secure all IRS data in a locked file for retention purposes. (Refer to DMA Administrative Letter 16-02.). This person is to distribute data to IMCs who must take any necessary action within 45 days and return the list with appropriate responses to the central person as per instructions in the DMA Administrative Letter regarding security of Internal Revenue Service and Social Security Administration information.

3. Counties must ensure that the FRR has been completed.

4. Within 45 days of the date on the report, or no later than the next case action or redetermination, whichever is earlier, complete the appropriate actions outlined below:

a. Upon receipt of the report, compare it to case record information.

(1) Complete matches showing the codes “A”, “B”, “C”, and “D” within the 45 day time standard.

(III.H.4.a.)

(2) Complete multiple matches for individuals with any combination of codes “A”,”B”, “C” and “D” with a “Z” or an “L” code within the 45 day time standard.

(3) Matches with code “L” only indicate that this match was reported to you in the last annual report or on a monthly report. If there is a QC error with an “L” match and the county has not completed the report within 45 days the error will be county responsible. Also, if there is a QC error with an “L” match and the documentation verifies that the match was unresolved when it was first reported, the error will be county responsibility.

If the value of the resource has changed and causes a QC error, it will be a client or county responsible error. It is the county’s responsibility for assuring all leads are followed up. If actions on all the reports were completed and all matches resolved and you have the documentation to support, these matches may be worked at the next change in situation or review.

(4) Matches with a code of “Z” may be completed at the next change in situation or review.

b. If the report shows information that has already been verified, document in the case record that the list was checked and return the report to the central person. Take no further action.

c. If the information is not known and there is a current release form (signed within the last 12 months), contact the appropriate agency to verify the information. If a current release form is not on file, contact the recipient and obtain a new signed release form.

d. Income reported and investigated in a prior year’s match as well as income from in-state unemployment and prior year’s federal and state refund may be excluded from follow-up.

e. Document the eligibility record and the Resource Report to substantiate that the “Resource Report” was checked and the results of the match. The following are suggested codes for the Resource Report (use all codes that are appropriate for each case):

(III.H.4.e)

CODE		DESCRIPTION
MR		Information matched record information
VC		Third party verification complete
VO		Third party verification outstanding
CO		Client notified of verification needed but still outstanding
NC		Information did not change benefits
BD		Benefits decreased - notice sent
BT		Benefits terminated - notice sent
DR		Documented record – action to be taken at next change in situation or review

I. IRS Yearly Match

1. The IRS match is conducted yearly in each aid program/category for ongoing recipients with a valid social security number. The yearly “Financial Resource Report” (FRR) match information is mailed to the counties in a hot pink envelope marked confidential. If the a/r’s SSN is not matched, no information is provided on the report.

2. IRS safeguards require that a central person in the county receive IRS data. This person must secure all IRS data in a locked file for retention purposes. This person is to distribute data to IMCs. The IMC must take any necessary action within 45 days and return the list with appropriate responses to the central person as per instructions in DMA Administrative Letter 16-02 regarding security of Internal Revenue Service and Social Security Administration information.

3. Counties must ensure that the FRR has been completed.

4. Within 45 days of the date on the report, or no later than the next case action or redetermination, whichever is earlier, complete the appropriate actions outlined below:

a. Upon receipt of the report, compare it to case record information.

(1) Complete matches showing the codes “A”, “B”, “C” and “D” within the 45 day time standard.

(III.I.4.a.)

(2) Complete multiple matches for individuals with any combination of codes “A”,”B”, “C” and “D” with a “Z” or an “L” code within the 45 day time standard.

(3) Matches with code “L” only indicate that this match was reported to you in the last annual report or on a monthly report. If there is a QC error with an “L” match and the county has not completed the report within 45 days the error will be county responsibility. Also, if there is a QC error with an “L” match and the documentation verifies that the match was unresolved when it was first reported, the error will be county responsibility. If the value of the resource has changed and causes a QC error, it will be a client or county responsible error. It is the county’s responsibility for assuring all leads are followed up.

If actions on all the reports were completed and all matches resolved and you have the documentation to support, these matches may be worked at the next change in situation or review.

(4) Matches with a code of “Z” may be completed at the next change in situation or review.

b. If the report shows information that has already been verified, document in the case record that the list was checked and return the report to the central person. Take no further action.

c. If the information has not been previously reported, attempt to obtain the information from the client. Follow the procedures in the DMA Administrative Letter 16-02 regarding security of Internal Revenue Service and Social Security Administration information.

d. Income reported and investigated in a prior year’s match as well as income from in-state unemployment and prior year’s federal and state tax refund may be excluded from follow-up.

e. Document the eligibility record and the Resource Report to substantiate that the “Resource Report” was checked and the results of the match. Refer to III.H.4.e. above for suggested codes to document the cases.

f. Resource Types

See Attachment 1 for a list of resource types and descriptions.