Assess whether identity proofing exceptions are being abused (1d87d5)

SITUATION A benefits issuance vendor after a file-control break cannot treat a CDR where treating-source evidence conflicts with a CE as incidental context on child-care attendance vs. school-calendar mismatches. Medicaid eligibility integrity analyst must close identity proofing exceptions are from that extract under Public Benefits / Recoupment and Policy.

DECISION Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break must choose Pay or continue / Recoup / Deny / Hold using child-care attendance vs. school-calendar mismatches after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. Child-care attendance vs. school-calendar mismatches reads as Pay or continue once a CDR where treating-source evidence conflicts with a CE is lined up to the same Public Benefits population. 2. Child-care attendance vs. school-calendar mismatches is closer to Recoup after a CDR where treating-source evidence conflicts with a CE; Pay or continue would over-claim this Recoupment and Policy extract. 3. Deny is still live in child-care attendance vs. school-calendar mismatches for Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break. 4. Child-care attendance vs. school-calendar mismatches is missing the fact Medicaid eligibility integrity analyst needs after a CDR where treating-source evidence conflicts with a CE; stop this Public Benefits close.

ANALYSIS REQUIRED 1. Separate a case-level error from a program-design failure in a benefits issuance vendor after a file-control break. 2. Match household facts in child-care attendance vs. school-calendar mismatches to the rule that pays the benefit. 3. Trace the notice and appeal path Medicaid eligibility integrity analyst must preserve. 4. For this Public Benefits Recoupment and Policy file, read child-care attendance vs. school-calendar mismatches against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move identity proofing exceptions are for Medicaid eligibility integrity analyst.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Recoupment and Policy packet (child-care attendance vs. school-calendar mismatches after a CDR where treating-source evidence conflicts with a CE). 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.

COMMAND RETURNS - Bottom-line Public Benefits option on identity proofing exceptions are, then the evidence in child-care attendance vs. school-calendar mismatches, then the action for Medicaid eligibility integrity analyst - Hypothesis scorecard against child-care attendance vs. school-calendar mismatches: supported / rejected / untestable - What changes identity proofing exceptions are if a CDR where treating-source evidence conflicts with a CE is later withdrawn - Named option among Pay or continue, Recoup, Deny and the fact that kills the others