Assess whether an eligibility case is error, fraud, or both (ff899a)

Situation

An identity-proofing vendor outage that opened a manual path put identity-proofing exception queue in front of Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break. This Public Benefits / Recoupment and Policy close is an eligibility case is from identity-proofing exception queue, and the live options are An eligibility case is error, fraud,, Both.

Decision

Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break must choose An eligibility case is error, fraud, / Both using identity-proofing exception queue after an identity-proofing vendor outage that opened a manual path.

Hypotheses to test

• Identity-proofing exception queue reads as An eligibility case is error, fraud, once an identity-proofing vendor outage that opened a manual path is lined up to the same Public Benefits population.
• Identity-proofing exception queue is closer to Both after an identity-proofing vendor outage that opened a manual path; An eligibility case is error, fraud, would over-claim this Recoupment and Policy extract.
• A dual reading is still live in identity-proofing exception queue for Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break.
• Identity-proofing exception queue is missing the fact Medicaid eligibility integrity analyst needs after an identity-proofing vendor outage that opened a manual path; stop this Public Benefits close.

Analysis required

• Trace the notice and appeal path Medicaid eligibility integrity analyst must preserve.
• Test eligibility, recoupment, and improper-payment facts in identity-proofing exception queue after an identity-proofing vendor outage that opened a manual path.
• Quantify overpayment if an eligibility case is is wrong.
• For this Public Benefits Recoupment and Policy file, read identity-proofing exception queue against an identity-proofing vendor outage that opened a manual path and write the one fact that would move an eligibility case is for Medicaid eligibility integrity analyst.

Recommendation

Choose An eligibility case is error, fraud, / Both on this Public Benefits / Recoupment and Policy packet (identity-proofing exception queue after an identity-proofing vendor outage that opened a manual path). The follow-on Recoupment and Policy action is what Medicaid eligibility integrity analyst does next: implement the option, assign an owner, and log the missing fact.