*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: May 1, 2012 |
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07.20.10 - Pending an Application |
Archived: June 1, 2016 (Previous Versions) |
In general, applications have a pending status when the application is not complete, information or verifications have not been received, or the client must pay a premium for eligibility to begin.
There are specific rules for each program on how to pend an application and what happens to a pended application.
Pending Applications - MinnesotaCare.
Pending Applications - MinnesotaCare
In addition to information found in Processing Applications, apply the information supplied in this section. There are two types of pending statuses for MinnesotaCare:
l Pending, awaiting payment.
A client is set to pending awaiting payment when determined eligible for MinnesotaCare.
n MMIS will determine the premium amount and generate the initial premium notice.
n The household has four months from the date the case is pended awaiting payment to make the first payment.
n MMIS automatically activates the case when the first payment comes in and is credited to the system.
n MMIS denies the case for nonpayment if the household does not send the initial payment within four months.
n The household must contact MinnesotaCare and provide updated information if they want MinnesotaCare after MMIS has denied the case for initial premium not received.
Note: A new application is not required if the household makes the request within 11 months of the initial application. See Application Required and Application Not Required.
l Pending, incomplete.
Clients who have not provided information or verifications to determine eligibility are pending, incomplete.
n Enter the following in MMIS:
m A begin date of the first of the following month.
m The appropriate pending reason codes on the RIND screen. MMIS will generate a pending notice listing the information needed to complete the application.
n MMIS will generate a notice informing the household that they must submit missing information for those members in 30 days if MMIS still shows eligibility for any household member as pending/incomplete at the time the following month’s billing is run.
n MMIS will send a notice of denial listing the reasons coded on RIND if the client is pending at the second billing.
Example:
Teresa submits an application on March 12 but does not include any income verification. The worker reviews the application on March 26 and is not able to verify the income electronically.
Action:
Enter the pending information on MMIS with a pending, incomplete span with a begin date of April 1.
MMIS generates a pending notice requesting income verification.
If the case is still pending/incomplete on May 15, when the May billing date is run, MMIS sends a notice advising Teresa that her application will be denied unless she submits the required information by June 15.
If the case is still pending/incomplete on June 15, MMIS sends a denial notice.
Pend applications on MAXIS. For MA purposes, a client is in a pending status when the application is incomplete, or there is not enough information or verification to determine eligibility.
If an applicant submits a Combined Application Form (CAF) or a request for coverage :
n Enter client information in the MAXIS APPL function (household member and address information, if known). This will set the request to a PND1 status and the case will be tracked on REPT/PND1. See MAXIS POLI TEMP TE02.05.27 Autodeny: REPT/PND1 and REPT/PND2 for information about MAXIS functionality.
n MAXIS will automatically deny the application on the 31st day after the application date in APPL if a completed application has not been received or if additional information is not entered in STAT on MAXIS.
n If a completed application is received after 30 days but before the end of the processing period and the request was auto-denied on MAXIS, reinstate the request and enter additional STAT data to move the case and each requesting member to a PND 2 status.
If an applicant submits any Minnesota Health Care Programs (MHCP) application:
n Enter client information in the APPL and STAT functions on MAXIS. This will set the request to a PND2 status and health care program information will appear on REPT/PND2. See MAXIS POLI TEMP TE02.05.27 Autodeny: REPT/PND1 and REPT/PND2 for information about moving a case from a PND1 to PND2 status in MAXIS.
n See Date of Application and How to Apply for more information on written health care requests.
If the county agency receives Applications for MHCP - SSA Data as a Request for MHCP:
n Enter client information from the MLAD panel into the APPL and STAT functions on MAXIS. This will set the request to a PND2 status and health care program information will appear on REPT/PND2. See MAXIS POLI TEMP TE02.07.243 REPT/PND2 for more information about pending a case in MAXIS.
n See MAXIS POLI TEMP TE02.07.459, ACCESSING MIPPA LIS APPLICATIONS, for more information on how to resolve a MIPPA LIS Application received from SSA.
Send a pending notice if eligibility is not determined by the end of the processing period.
l MAXIS will generate the pending notice 10 days before the end of the processing period if the application is set to a PND2 status. The MAXIS code on PND2 defaults to indicate agency delay on the notice. Follow the instructions in Notices to explain to the applicant why the application has not been processed if the delay is due to worker or agency delays, or other circumstances not related to the applicant's failure to provide information.
l Code PND2 to indicate client delay if the delay is due to the applicant’s failure to provide information. MAXIS will send the pending notice 10 days before the last day of the processing period. The notice tells the client that the agency will deny the application unless the applicant provides information within 10 days from the date of the notice.
n Follow the instructions in Notices to explain to the applicant what must be done to complete the application process.
n Deny eligibility if the client fails to respond within 10 days from the date of the pending notice.
n Do not deny if the applicant is attempting to cooperate but is having difficulty obtaining the information.
Help the applicant obtain the information. If the applicant must pay a fee for a particular document and cannot afford it, pay for the document using MA administrative funds.
For additional information on PND2 notices and coding see MAXIS POLI TEMP TE02.07.243 REPT/PND2. This reference contains information on how to enter codes on MAXIS to generate notices to clients when a health care request is pending and the application process is delayed.