Medical

Created on: 
Sep 15 2017
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Married couple both eligible for Medicare in S05 (Special Low-Income Medicare Beneficiary)/S06 (Qualified Individual) creates infinite loop issues (PR 5866)

Situation:

When one spouse in a married couple receives Supplemental Security Income (SSI), both clients are eligible for Medicare, and active on an S05 Assistance Unit (AU), ACES trickles to S06 if their combined other income exceeds the S05 standard. ACES then reviews eligibility on the S06 AU, notices the couple is active on medical, and then flips back to an S05 AU. This loop of going back and forth from S05 to S06 will continue indefinitely. If an AU is caught in this type of infinite loop, a data fix needs to be done by contacting ITS Customer Support at (360) 664-4560.

To avoid this infinite loop issue, follow the recommended procedure listed below.

Workaround:

Open a separate S03 (Qualified Medicare Beneficiary) AUs for each spouse. Based on income, the S03 (QMB) AU will trickle to a S05 AU program. See the Medicare Savings Program - Qualified Medicare Beneficiary (QMB) - S03 chapter for more information on screening and processing an S03 AU.

When taking actions on a case that requires a Processing Alternative (PAL), please make sure to narrate your actions.

No Spenddown segment created when some months are approved / denied in ACES, also rejects in ProviderOne (PR 322946)

Situation:

When approving and denying some months of a Spenddown Assistance Unit (AU) in ACES Mainframe or 3G in the same finalize session, the system doesn't create the Spenddown segment. This prevents processing the Spenddown correctly in ACES.online and creates a rejected record in ProviderOne.

Workaround:

To process Spenddown AUs when only some months should be active, follow the steps below for pending Spenddown AUs before processing related medical AUs.

  1. Finalize the Spenddown AU, bringing it to active M-Status, through the ongoing benefit month.
  • If processing a retroactive base period, screen an AU back to the first day of the first month in the retroactive period; then finalize the AU through the ongoing month.
  1. Access the Spenddown page in ACES.online and update the Spenddown Base Period fields to the correct months needed.
  2. Wait overnight.
  3. The following day in ACES 3G, manually deny out the benefit months that are not included in the modified base period from Step 2.

Letter 020-01 (MN Spenddown) displays the correct base period and Spenddown liability for the modified base period. Additionally, this workaround allows users to authorize the Spenddown in ACES.online.

When taking actions on a case that requires a Processing Alternative (PAL), please make sure to narrate your actions.
 
 
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.