Assess whether identity proofing exceptions are being abused (07ac11)

SITUATION In a Medicaid agency with a surge in MAGI mismatches, identity-proofing exception queue is the evidence after a MAGI mismatch that could be a household-size coding error. Issuance-system integrity manager has to pick Pay or continue or Recoup for this Public Benefits Recoupment and Policy close using identity-proofing exception queue.

DECISION Issuance-system integrity manager in a Medicaid agency with a surge in MAGI mismatches must choose Pay or continue / Recoup / Deny / Hold using identity-proofing exception queue after a MAGI mismatch that could be a household-size coding error.

HYPOTHESES TO TEST 1. Authorize Pay or continue now; identity-proofing exception queue already has the discriminator after a MAGI mismatch that could be a household-size coding error. 2. Keep Recoup in force until identity-proofing exception queue is completed after a MAGI mismatch that could be a household-size coding error for issuance-system integrity manager. 3. Treat identity-proofing exception queue as Deny because both readings appear after a MAGI mismatch that could be a household-size coding error. 4. Refuse a Public Benefits close: issuance-system integrity manager does not have the decision identity proofing exceptions are turns on in identity-proofing exception queue.

ANALYSIS REQUIRED 1. Match household facts in identity-proofing exception queue to the rule that pays the benefit. 2. Trace the notice and appeal path issuance-system integrity manager must preserve. 3. Test eligibility, recoupment, and improper-payment facts in identity-proofing exception queue after a MAGI mismatch that could be a household-size coding error. 4. For this Public Benefits Recoupment and Policy file, read identity-proofing exception queue against a MAGI mismatch that could be a household-size coding error and write the one fact that would move identity proofing exceptions are for issuance-system integrity manager.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Recoupment and Policy packet (identity-proofing exception queue after a MAGI mismatch that could be a household-size coding error). Lead with the Public Benefits option identity-proofing exception queue can support after a MAGI mismatch that could be a household-size coding error, then the two facts that force it, then the Monday action for issuance-system integrity manager in a Medicaid agency with a surge in MAGI mismatches.

COMMAND RETURNS - Bottom-line Public Benefits option on identity proofing exceptions are, then the evidence in identity-proofing exception queue, then the action for issuance-system integrity manager - Hypothesis scorecard against identity-proofing exception queue: supported / rejected / untestable - What changes identity proofing exceptions are if a MAGI mismatch that could be a household-size coding error is later withdrawn - Named option among Pay or continue, Recoup, Deny and the fact that kills the others