Assess whether a provider's attendance is fabricated (86b2a1)

Situation

After a thousand UI claims from one IP block, TANF work-hours that cannot be corroborated is what Medicaid eligibility integrity analyst can touch in a benefits issuance vendor after a file-control break. Public Benefits will live with Pay or continue versus Recoup on this Recoupment and Policy file.

Decision

Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break must choose Pay or continue / Recoup / Deny / Hold using TANF work-hours that cannot be corroborated after a thousand UI claims from one IP block.

Hypotheses to test

• TANF work-hours that cannot be corroborated reads as Pay or continue once a thousand UI claims from one IP block is lined up to the same Public Benefits population.
• TANF work-hours that cannot be corroborated is closer to Recoup after a thousand UI claims from one IP block; Pay or continue would over-claim this Recoupment and Policy extract.
• Deny is still live in TANF work-hours that cannot be corroborated for Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break.
• TANF work-hours that cannot be corroborated is missing the fact Medicaid eligibility integrity analyst needs after a thousand UI claims from one IP block; 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 TANF work-hours that cannot be corroborated after a thousand UI claims from one IP block.
• Quantify overpayment if a provider's attendance is is wrong.
• For this Public Benefits Recoupment and Policy file, read TANF work-hours that cannot be corroborated against a thousand UI claims from one IP block and write the one fact that would move a provider's attendance is for Medicaid eligibility integrity analyst.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Recoupment and Policy packet (TANF work-hours that cannot be corroborated after a thousand UI claims from one IP block). Lead with the Public Benefits option TANF work-hours that cannot be corroborated can support after a thousand UI claims from one IP block, then the two facts that force it, then the Monday action for Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break.