Special Assistance SA-3400 AUTOMATED INQUIRY AND MATCH PROCEDURES

III. MATCH REPORTS

A. Social Security Number Validation Discrepancy Report

1. A SSN Validation Discrepancy Report is generated when:

a. Validation cannot be accomplished based on the match with NUMIDENT or BENDEX, or

b. Program data differs in MCI.

2. Counties must resolve discrepancies to ensure more accurate automated matches. Reports are sorted in worker number order and include all identifying case information along with a discrepancy message.

The report is generated for the program (PROG) specified. The report gives the district/worker number (DIST#), county case number (CTY CASE) and case ID number (SYS CASE).

The following discrepancy messages will appear on the report:

a. DOB Does Not Match

b. Name Does Not Match

c. SSN Not in SSA File

d. SSN Does Not Match

e. * Items Do Not Match

f. DOB Does Not Match Bendex

3. If the report message consists of only one line, your individual data was used to attempt the validation when it was sent to SSA. This also indicates no other program's data has been validated for your individual. The reason for non-validation is indicated by the discrepancy message and an asterisk (*).

a. Research the individual to ensure that EIS contains the correct SSN, name and date of birth. Be sure to check for keying errors. If you are successful in resolving the discrepancies in the vital data, update the data field in question in the Name Change screen in EIS. This causes the data to be re-sent for validation.

b. If the individual's correct SSN has already been used in EIS:

(1) Call EIS/DMA staff at (919) 857-4019 if the individual with the incorrect SSN is a SSI recipient.

(2) Call the Medicaid worker for the case in all other situations to resolve the discrepancy.

4. Resolving Two Line Messages

If you receive a two line error message on your discrepancy report, this indicates that the individual record in MCI for the program listed on line 01 has validated with SSA. The report is sent to the worker to resolve a discrepancy for the individual on line 02.

a. If you find that the first line lists an individual who is not the same person who is listed on the second line, then these individuals have been matched in MCI erroneously.

b. To verify this is the problem, follow the instructions below.

(1) First do a client inquiry using either of the two individuals listed on the discrepancy report.

(2) Obtain the Match ID.

(3) Then do a Match ID inquiry with the Match ID. You should see the other individual who was listed on your report.

(4) To correct this problem, follow instructions found in EIS User's Manual, EIS 1057, VI.B. for client unmatching.

(5) After unmatching the individuals in MCI, the unvalidated record is submitted to SSA for validation.

5. Allowing Time for Systems to Work

When you respond to a SSN Validation Discrepancy Report by correcting information in EIS or MCI, you must allow at least 60 days for the validation process to work.

6. Requests for Manual Validations

Before pursuing manual validations, compare your EIS profile to the SS card and birth information in the record. If the information in EIS matches the information on the SS card and birth verification, pursue manual validation. If you are unable to enter the SSN into EIS, determine if another individual in EIS had this number. Refer to III.A.3.b. above.

a. When requesting a manual validation, you must send all of the following to IEVS Coordinator:

IEVS Coordinator (check all these)

1985 Umstead Drive

Raleigh, NC 27626-0529

(1) Copy of the discrepancy report.

(2) Your name and telephone number.

(3) Copy of the SS card showing same name and number as in EIS. If you don't have a copy of the SS card, send a copy of the on-line SDX.

(4) Copy of the birth certificate or copy of BENDEX showing same DOB as in EIS.

(5) Copy of the most recent EIS case profile.

If the IEVS Coordinator has questions, he/she will contact you. If the request is not pursued, the IEVS Coordinator will return your request with an explanation. Requests are not pursued when the information received is not complete according to the above list. Another reason may be that your request does not require the manual validation process such as the client needs to go to SSA or EIS needs to be updated.

b. The IEVS Coordinator will confirm with SSA that this is the correct SSN for this individual. If all information is correct, State staff will enter a validation code "M" on the MCI validation screen. The "M" code indicates that a manual validation has been completed for that SSN. The IEVS Coordinator will send you a letter if SSA's data is incorrect. At the next review, inform the a/r that he may want to contact SSA to make corrections in their data. Inform the a/r that this will not affect his/her eligibility.

This manual validation process takes some time to complete. It is possible that these individuals will appear on the SSN Discrepancy Reminder Report. Do not send the information to the IEVS Coordinator a second time.

However, once the "M" code appears on the MCI validation screen, EIS will no longer generate the Discrepancy or Reminder Reports.

7. Resolving Discrepancies When Incorrect Data Validates

Because SSA does not require an exact match for validation, there are cases where the SSN with wrong vital data validates and the program with the correct data shows a discrepancy. The program with the wrong data must make the necessary corrections to its base system, regardless of whose data validated.

Whenever a change is made in the vital data in EIS, the SSN is automatically resubmitted for validation. At that time, the SSN will validate and MCI automatically validates the other matched program since they are now identical.

B. SSN Validation Reminder Report

In addition to the SSN Validation Discrepancy Report, you receive an SSN Validation Reminder which includes individuals from earlier discrepancy reports on which no action has been taken.

The report is printed in the same format as the Discrepancy Report.

1. The report is generated when:

a. No action has been taken within 45 days of the original discrepancy report, or

b. An individual has been in EIS more than 125 days with no SSN.

If you have taken action but it has not had time to be completed (such as requesting manual validation), these individuals continue to be listed on the Reminder Report. It is not necessary to take the action a second time.

2. "Needs SSN" Message

This message appears on the SSN Validation Reminder Report and indicates that the individual is in EIS without an SSN. You should obtain an SSN and update EIS.

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. In addition to the on-line BENDEX, the computer prints an individual BENDEX information sheet identifying the recipient and the current status of his/her SSA benefits. The IMC will receive a BENDEX sheet on an a/r when:

a. He/She first receives Social Security,

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

c. There is a change in hospital benefits,

d. He/She is entitled to insurance or supplemental Medicare insurance,

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

3. Because the BENDEX sheets indicate a change in the a/r's SSA data, compare this information with the case record each time a BENDEX sheet is received. Take any necessary action 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 charges were previously unreported, document the record to substantiate that the BENDEX was checked and to reflect the results of the match.

D. SDX

1. Paper updates are generated on a daily basis to provide current input on accretions, deletions, changes of address, or other changes in situation occurring after the monthly tape is run.

2. In addition to the on-line SDX, the computer generates an individual SDX information sheet identifying the recipient and the current status of his/her SSI benefits. The IMC will receive a SDX sheet when:

a. He/She first receives Supplemental Security Income; or

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

(1) Payee name and address

(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

(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

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

3. Because the SDX sheets indicate a change in the a/r's SSI data, 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.

4. SDX Udpate Report

a. A master list entitled "SDX Updates" is produced annually reflecting Cost-of-Living Adjustment (COLA) information.

b. One copy of the annual SDX Updates Report must be kept until receipt of the Next printout and must be available for review by Income Maintenance or Quality Control staff.

E. Quarterly ESC Match

1. The quarterly match reports are produced through a computer match of the ESC/UI and eligibility files. Reports are transmitted to counties within one month following the end of the quarter. Due to ESC procedures for compiling data, there is a quarter lag in the information received. The match is produced in addition to the online 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 report, check each match against your caseload.

b. If the report shows reported employment of or UI for a/r, 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.

F. 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. The BEER report must be received by a central person in the county. This person is to distribute data to IMC's, who must take any necessary action within 45 days and return the report to the central person.

3. This person must secure all BEER data in a locked file for retention purposes.

4. 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 the earnings.

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

G. 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. (Refer to II.H., below, for information on the yearly match for ongoing recipients). Monthly match information is mailed to the counties in a "Financial Resource Report" (FRR). If the a/r's SSN is not matched, no information is provided on the report.

2. IRS safeguards require that IRS data be received by a central person in the county. This person is to distribute data to IMC's, who 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 39-87. This person must secure all IRS data in a locked file for retention purposes.

3. 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) Matches showing the codes "A", "B", "C", and "D" must be completed within the 45-day time standard.

(2) Multiple matches for individuals with any combination of codes "A","B", "C" and "D" with a "Z" or and "L" code must be completed 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 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 to substantiate that the "Resource Report" was checked and the results of the match.

f. Document actions taken on the Resource Report. The following are suggested codes (use all codes that are appropriate for each case):

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

H. IRS Yearly Match

1.

The IRS match is conducted yearly in each aid program/category for recipients with a valid social security number. The yearly match information is mailed to the counties in a "Financial Resource Report" (FRR). If the a/r's SSN is not matched, no information is provided on the report.

2. IRS safeguards require that IRS data be received by a central person in the county. This person is to distribute data to IMC's, who 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 39-87. This person must secure all IRS data in a locked file for retention purposes.

3. Counties are responsible for assuring the FRR has been completed. If there is a QC error with an "L" match and the county has not completed the report within 45 days or if the documentation verifying 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 an error, it will be a client or county responsible error. It is the county's responsibility for assuring all leads are followed up.

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) Matches showing the codes "A", "B", "C" and "D" must be completed within the 45-day time standard.

(2) Multiple matches for individuals with any combination of codes "A","B", "C" and "D" with a "Z" or and "L" code must be completed 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 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 to substantiate that the "Resource Report" was checked and the results of the match.

f. Document action taken on the Resource Report. Refer to III.G.3.f. above for suggested codes to document the cases.

g. Resource Types (Refer to SA-3400 Figure 2).