Medical

Created on: 
May 23 2018
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

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.

Tailored Supports for Older Adults (TSOA) Assistance Units (AUs) approve if over income and resources - Transportation for Disabled (TD) vehicle coded (PR 432636)

Situation:

In some situations TSOA AUs approve when over the income and resource standards and a TD vehicle type is coded. ACES incorrectly allows resource deductions even though the initial resource test fails. When this occurs, the system ignores the income and doesn't deny the AU for Reason Exceeds Income Standard (301).

Workaround:

At this time, please call IT Solutions Customer Support at (360) 664-4560, Option 2 for an appropriate workaround.

Medicare Buy-In Unit Cannot Update or Modify TPL Screen in ACES 3G (PR 422917)

Situation:

After the January 2018 ACES promote of Change Request 387494 - MEDICARE BENEFICIARY IDENTIFIER (MBI) - 3G/ACESONLINE MBI NUMBER FIELD, staff in the Medicare Buy-In Unit (MBU) could not update Third-Party Liability (TPL) information in ACES 3G. This adversely effects staff trying to process Medicare Savings Program (MSP) Assistance Units (AUs) when there is outdated or incorrect Medicare TPL begin or end dates that have a source code of MMIS/P1 Interface (MM).  This situation also affects staff who are trying to process Modified Adjusted Gross Income (MAGI) AUs. 

Workaround:

At this time, please call IT Solutions Customer Support at (360) 664-4560, Option 2 for an appropriate workaround.

S02 Incorrectly Approves With SSI Recipient Spouse When the SSI-Related Applicant is Not Eligible for Special Income Disregard (CR 391840)

Situation:

When processing an SSI Related Categorically Needy (S02) Assistance Unit (AU) where there is a Supplemental Security Income (SSI) recipient spouse on the AU, S02 medical incorrectly approves for the SSI-related applicant when:

  • Their income is less than the 1-person SSI-related Categorically Needy Income Limit (CNIL) standard; and

  • They are not eligible for an SSI-related special income disregard.

S02 should only be approved when there is an SSI recipient spouse if the SSI-related applicant is deemed eligible for SSI with one of the special income disregards.

For more information about eligibility for SSI-related special income disregards, see Apple Health Manual – Income Special Disregards.

Workaround:

At this time, please call IT Solutions Customer Support at (360) 664-4560, Option 2 for an appropriate workaround.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.