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Effective: February 1, 2008 |
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07.20.10ar2 - Pending an Application (Archive) |
Archived: February 1, 2009 |
In general, applications have a pending status when the application is not complete, information and/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 - MA/GAMC.
In addition to information found in Processing Applications, apply the information supplied in this section. There are two types of pending for MinnesotaCare (MCRE):
l Pending awaiting payment.
A client is set to pending awaiting payment when determined eligible for MCRE.
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 If the household does not send the initial payment within four months, MMIS denies the case for no payment.
n The household must contact MCRE and provide updated information if they want MCRE 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 If MMIS still shows eligibility for any household member as pending/incomplete at the time the following month’s billing is run, MMIS will generate a notice informing the household that they must submit missing information for those member(s) in 30 days.
n If the client is pending at the second billing, MMIS will send a notice of denial listing the reasons coded on RIND.
Example:
Teresa submits an application on March 12. The worker reviews the application on March 26 and determines that Teresa needs to supply income verification.
Action:
The worker enters the pending information on MMIS with a pending, incomplete span with a begin date of April 1.
MMIS generates a pending notice requesting the 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.
Pending Applications - MA/GAMC
For MA/GAMC purposes, a client is in a pending status when the application is incomplete, or there is not enough information or verification to determine eligibility.
Send a pending notice if you have not determined eligibility by the end of the processing period.
l If the delay is due to worker or agency delays, or other circumstances not related to the applicant's failure to provide information, explain the reason for the delay in a notice.
l If the delay is due to the applicant’s failure to provide information, send a pending notice 10 days before the last day of the processing period.
n The notice must say that the agency will deny the application unless the applicant provides the information within 10 days of the date of the notice.
n If the client fails to respond, send a denial 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 or GAMC administrative funds.
Pend the application on the following MAXIS screens:
l PND1, if an applicant submits only a Combined Application Form (CAF) Part I or a request for coverage.
n Follow the CAF instructions in the DHS Combined Manual and MAXIS POLI TEMP to load an application into PND1.
n MAXIS will automatically deny the application after 30 days if a completed application has not been received.
n If a completed application is received after 30 days but before the end of the processing period, reinstate the request and move it to a PND 2 status.
l PND2, if an applicant submits any application form for health care programs.
n See Date of Application and How to Apply for more information on written health care requests.
For additional information on pending the application on MAXIS see TE02.07.243. This MAXIS TEMP Manual reference contains information on REPT/PND2 and sending notices of delay.