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Effective: December 1, 2006 |
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07.20ar1 - Processing Applications (Archive) |
Archived: February 1, 2008 |
All of the health care programs require that applications be processed as soon as possible, and within a certain number of days from the date of application.
What Does It Mean to Process an Application?
What is a Complete Application?
Application Processing Step 1 - Review for Completeness.
Application Processing Step 2 - Interview (Optional).
Application Processing Step 3 - Determine Eligibility.
What Does It Mean to Process an Application?
Processing the application means gathering and reviewing all the information you need to determine eligibility and determining eligibility.
l For MinnesotaCare (MCRE) purposes, an application is considered processed even if the eligibility determination results in a pending status. If the client does not return missing information the application will automatically be denied by the system.
l For MA/GAMC an application is considered completely processed when eligibility is approved or denied.
There are processing standards that must be followed. See Processing Period Standards for more information.
What is a Complete Application?
A complete application has:
l All questions answered that are needed to determine eligibility.
Note: Do not require that all questions on the application be answered to determine if people are eligible, if there is enough information to make that determination.
l All required information and verifications have been received.
l Been signed and dated by people required to sign the application. See Application Signature.
Application Processing Step 1 - Review for Completeness
Review the application for completeness as soon as possible.
l Contact the client by phone or mail to request missing items, information on the application that needs clarification and mandatory verifications that have not been provided.
Allow at least 10 days for the applicant to respond to the request for more information.
n Do not deny the application for failure to return the required information before the end of the processing period.
You must give the applicant 10-day notice of the proposed denial at the end of a processing period.
n If the applicant returns the missing information or verification, continue on to Step 3.
l Request the original application if the application was submitted by fax.
Note: The original application form must be submitted within 30 days of the date of application.
n Do not wait to approve eligibility if the faxed application includes all information and verifications needed to determine eligibility.
n See How to Apply for more information on faxed application.
l Check MMIS to see the status of each household member to determine if any members of the household are active on another health care program.
When an applicant is already open on one program and requests a different program, coordinate coverage. See Eligibility Begin Date for more information on coordinating coverage.
Application Processing Step 2 - Interview (Optional)
Do not require an interview for health care program eligibility.
l If an interview is requested by the client, schedule it as soon as possible.
n Schedule interviews for pregnant women requesting an interview within five days from the receipt of the application.
n Schedule interviews for people with a medical emergency in time to meet the emergent need.
n Review the application with the client during the interview.
n Because of the complexity of Long-term Care (LTC) and Elderly Waiver (EW) eligibility, counties may strongly encourage an in-person meeting, but it cannot be required.
n The interview can be scheduled with the county of residence or county of financial responsibility of the client, or the county of residence of the authorized representative.
l If an interview is not requested, go directly to Step 3.
Application Processing Step 3 - Determine Eligibility
Determine eligibility for all people requesting coverage following these steps.
1. For MinnesotaCare and GAMC applications:
Determine if the client previously was eligible for or applied for MA. If the client was denied or closed from MA based solely on failure to provide asset verification, see MA Asset Verification Denial/Closure to determine if MinnesotaCare or GAMC eligibility is affected.
2. Enter case information on the appropriate system.
l MCRE: MMIS.
n Check to see if each person has a Person Master Index (PMI) Number. Ensure that a PMI number is assigned for each person who does not have one.
n Assign a provider number and a case number.
n MMIS will show the case status as Pending Representative Review (PRR) until the worker determines eligibility.
l MA/GAMC: MAXIS and MMIS.
3. Determine if each person applying is approved, denied or pending.
l If the application is complete, approve or deny eligibility within the processing period. Send an approval or denial notice.
See Notices for more information.
Note: MCRE refers to approval as pending awaiting payment.
l If the application is not complete and more information or verifications are needed to determine eligibility, send a pending notice to the client.
See Pending Applications for more information on policy regarding pending applications.
l If the processing period ends and the application continues to be incomplete, deny eligibility. Send a denial notice for failure to follow through with the application process.
Note: MCRE cases will be auto-denied by MMIS.