Assess whether to recoup, waive, or refer for prosecution (70267a)

SITUATION After a CDR where treating-source evidence conflicts with a CE, disability CDR medical-evidence pack is what Medicaid eligibility integrity analyst can touch in a benefits issuance vendor after a file-control break. Public Benefits will live with To recoup, waive, versus Refer for prosecution on this Recoupment and Policy file.

DECISION Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break must choose To recoup, waive, / Refer for prosecution using disability CDR medical-evidence pack after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. Medicaid eligibility integrity analyst can defend To recoup, waive, from disability CDR medical-evidence pack after a CDR where treating-source evidence conflicts with a CE in a Public Benefits challenge. 2. Medicaid eligibility integrity analyst cannot defend To recoup, waive, from disability CDR medical-evidence pack; Refer for prosecution is what the extract actually supports after a CDR where treating-source evidence conflicts with a CE. 3. A CDR where treating-source evidence conflicts with a CE never reached the population in disability CDR medical-evidence pack — reopen intake, do not close to recoup, waive, or refer. 4. Two facts in disability CDR medical-evidence pack after a CDR where treating-source evidence conflicts with a CE conflict for Medicaid eligibility integrity analyst; hold this Recoupment and Policy file.

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 disability CDR medical-evidence pack 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 disability CDR medical-evidence pack against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move to recoup, waive, or refer for Medicaid eligibility integrity analyst.

RECOMMENDATION Choose To recoup, waive, / Refer for prosecution on this Public Benefits / Recoupment and Policy packet (disability CDR medical-evidence pack after a CDR where treating-source evidence conflicts with a CE). Lead with the Public Benefits option disability CDR medical-evidence pack can support after a CDR where treating-source evidence conflicts with a CE, 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.

COMMAND RETURNS - Bottom-line Public Benefits option on to recoup, waive, or refer, then the evidence in disability CDR medical-evidence pack, then the action for Medicaid eligibility integrity analyst - Hypothesis scorecard against disability CDR medical-evidence pack: supported / rejected / untestable - Owner and next date for Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break - What changes to recoup, waive, or refer if a CDR where treating-source evidence conflicts with a CE is later withdrawn