Assess whether a provider's attendance is fabricated (4ae0ab)

Situation

In a Medicaid agency with a surge in MAGI mismatches, identity-proofing exception queue is the evidence after a CDR where treating-source evidence conflicts with a CE. 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 CDR where treating-source evidence conflicts with a CE.

Hypotheses to test

• Issuance-system integrity manager can defend Pay or continue from identity-proofing exception queue after a CDR where treating-source evidence conflicts with a CE in a Public Benefits challenge.
• Issuance-system integrity manager cannot defend Pay or continue from identity-proofing exception queue; Recoup is what the extract actually supports after a CDR where treating-source evidence conflicts with a CE.
• A CDR where treating-source evidence conflicts with a CE never reached the population in identity-proofing exception queue — reopen intake, do not close a provider's attendance is.
• Two facts in identity-proofing exception queue after a CDR where treating-source evidence conflicts with a CE conflict for issuance-system integrity manager; hold this Recoupment and Policy file.

Analysis required

• Match household facts in identity-proofing exception queue to the rule that pays the benefit.
• Trace the notice and appeal path issuance-system integrity manager must preserve.
• Test eligibility, recoupment, and improper-payment facts in identity-proofing exception queue after a CDR where treating-source evidence conflicts with a CE.
• For this Public Benefits Recoupment and Policy file, read identity-proofing exception queue against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move a provider's attendance is 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 CDR where treating-source evidence conflicts with a CE). The follow-on Recoupment and Policy action is what issuance-system integrity manager does next: implement the option, assign an owner, and log the missing fact.