Revision 18-2; Effective June 1, 2018

 

R-3100 Establish Processing Deadlines

Revision 12-2; Effective June 1, 2012

 

When taking an application, designated staff complete Application Registration. Applications are tracked using TIERS and Data Mart reports.

When the application is for a person who is younger than 65 and has never had a disability determination, the eligibility specialist must pend for Disability on the Disability – Details page and run Eligibility Determination and Benefit Calculation (EDBC) to override the application due date default of 45 days. The application due date will be 90 days from the file date. If the application is not pended appropriately, the application will be delinquent in 45 days.

Sometimes an application cannot be certified before the 45th/90th day. In these cases complete Form H1215, Report of Delay in Certification, and submit the form for approval. Once approval for the delay is received, send Form H1247, Notice of Delay in Certification, to the applicant and the facility administrator. Enter appropriate information in TIERS to initiate the delay in certification.

Note: Do not send Form H1247 if certification is delayed because Home and Community-Based Services waiver services are pending. No notification is required for those cases because services have not yet begun.

Applications for which delay-in-certification procedures have been followed are excluded from the delinquent count in timeliness reports. However, the exclusion is only for a specific period of time, as follows:

  • Applications for persons age 65 or older are excluded for 135 days (45 + 90-day extension); however, if the application is still pending on the 136th day, it will be counted as delinquent.
  • Applications for persons under age 65 who have never had a disability determination are excluded for 180 days (90 days + 90-day extension); however, if the application is still pending on the 181st day, it will be counted as delinquent.

Applications that cannot be certified within the normal 45/90-day limit, plus the 90-day extension, must be denied. A new application will be necessary to reconsider eligibility.

 

TIERS Delay Reasons Drop-down

  • 30-day consecutive requirement not met
  • Medical necessity decision is pending
  • Level of care decision is pending
  • Disability determination pending
  • Home and Community-Based Services waiver services pending
  • Nursing facility pending certification
  • New resource/information received after 30th day
  • Resource spend-down
  • Miscellaneous
  • CC Pending
  • Documentation of citizenship and identity
  • Legal review of documents

 

R-3200 Case Number

Revision 12-2; Effective June 1, 2012

 

When an application for assistance is entered into the system for the first time a unique 10-digit application number is assigned. The application number begins with the letter T. The letter T changes to the number one when the application moves to Data Collection and becomes a case. The case number is unique to that household. The household members may consist of more than one individual on more than one HHSC programs including Texas Works as well as MEPD programs.

If a certified member of the household leaves the household and establishes a new household, a new case is created and a new case number is assigned for the member who left the original household.

 

R-3210 Association of Case Number

Revision 12-2; Effective June 1, 2012

 

When a former recipient reapplies for assistance during File Clearance, determine if the individual should be associated to a former case number. This includes associating a former case number to a person who applies for ME – A and D-Emergency.

 

R-3300 Client/Individual Number

Revision 12-2; Effective June 1, 2012

 

The first time a person is certified by HHSC, a unique client/individual number is automatically assigned by state office. Once assigned, the number must be used by all program areas. The client/individual number is used in the system to locate identification information, certain types of income, Medicaid coverage and the numbers for all Edges in which the person appears.

Individuals certified under the legacy system (SAVERR) had their client numbers changed to nine-digit individual numbers at TIERS conversion.

 

R-3310 Association of Client/Individual Number

Revision 12-2; Effective June 1, 2012

 

During application registration, a procedure called File Clearance is performed on each individual that is recorded on the Individual Logical Unit of Work (LUW).

File Clearance is a process that compares the demographic information for an applicant (SSN, name, date of birth, gender and so on) against information in the Master Client Index (MCI). The MCI is a database containing information on all individuals known to the agency. Known to the agency means the individual has been on an application or case in either TIERS or the SAVERR legacy system.

File Clearance identifies and displays individuals whose information may match the application individual. If a match occurs, staff must investigate the matches to determine whether the applicant is in fact one of these people, or is a person completely new to the agency. The purpose of this process is to avoid duplicate individual information and duplicate cases or applications by reassigning the existing client/individual number.

Note: TIERS scores a match at 100% only when the first name, last name, SSN, DOB and gender are provided and that information matches an existing individual. Many instances exist where no Social Security number is available, and it sometimes is not required; therefore, staff should not assume the person is new to the system when the score is not a 100% match. Staff must be sure the person is new to the system before creating a new client/individual number and avoid creating multiple client/individual numbers for the same person.

When an individual is a match for an applicant, staff have various options that depend on whether the need is to match the application to an entire case or only to selected individuals. Associate the application to an existing TIERS case or application, or add TIERS individuals from an existing case to the new application.

 

R-3400 Merge and Separate Client/Individual Numbers

Revision 12-2; Effective June 1, 2012

 

Situations may arise when a person is erroneously assigned more than one client/individual number or when two or more people are assigned the same client/individual number. Eligibility specialists must resolve the situation by requesting the client/individual numbers be merged or separated, depending on the situation.

Staff use the TIERS functional area on the left navigation bar named Merge/Separate to request a merge or separate and the following procedures.

 

Merge

Use Request Merge when more than one Individual number has been assigned to a single person.

  • Enter a minimum of two, up to 10 Individual numbers to be merged and enter the mandatory comments explaining the reason for the merge request.
  • Upon entry of the Individual number in the Individual number field and clicking on the Add button, the demographic information associated with that Individual number will be displayed in the Selected Individuals section. If it is not the correct person, delete the entry using the delete icon or use the binoculars icon to search for the individual using demographic data. This is similar to the individual search in Inquiry.
  • Once all of the Individual numbers and mandatory comments are entered, click the Submit button to send the request to Data Integrity.

 

Separate

Use Request Separate when more than one person is assigned to a single Individual number.

  • Enter one Shared Individual number and up to three Individual numbers to be separated. Enter mandatory comments explaining the reason for the separate request.
  • Upon entry of the Individual number in the Shared Individual number field or demographic information and clicking on the Add button, the demographic information associated with that Individual number will be displayed in the Selected Shared Individuals and Shared ID above is to be separated to these individuals sections if it is not the correct person. Delete that entry using the delete icon or use the binoculars icon to search for the individual using demographic data, similar to the individual search in Inquiry.
  • Once all of the Individual numbers and mandatory comments are entered, click the Submit button to send the request to Data Integrity.

When the eligibility specialist enters an Individual number that already exists on a merge or separate request, it cannot be requested again and a validation message will be displayed. When TIERS displays a validation message, staff must either correct the information, if entered incorrectly, or use Search Merge/Separate to determine if the Individual number(s) on the request are associated with the same Individual number.

 

Tracking Progress

Use Search Merge/Separate to track the progress of the request. Some requests will take longer than others. This may occur when the Individual received MEPD coverage in addition to the Texas Works benefits they receive in TIERS. These requests are placed on hold until the request can be processed in TIERS.

Data Integrity staff can mark an Individual number as a potential duplicate (PD) when a merge or separate request is made. Staff cannot select an Individual number for addition to new cases if it is marked as PD, which limits the potential for the wrong Individual number to be awarded benefits or coverage in error.

Questions about a merge or separate request should be sent to the Data Integrity mailbox at tiers_statepaidmedicaid@hhsc.state.tx.us

 

R-3500 Information Maintained in Automated System

Revision 12-2; Effective June 1, 2012

 

When a person is certified for assistance, the following information is kept electronically:

  • Identification data
  • Client/Individual number
  • Name
  • Birth date
  • Sex
  • Race
  • Social Security account number
  • Social Security claim number
  • Client Residence County Code

The county related to the person's home address is used. For residents of a long-term care facility, record the county for the facility address. The person's residence county should be updated whenever there is a change of address involving a new county. This entry is used to identify a person who is eligible or required to enroll in managed care. It is also used by the Service Authorization System Online (SASO).

 

R-3600 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

 

R-3700 Automated Verification Systems

Revision 12-2; Effective June 1, 2012

 

Through interagency agreements, several automated verification systems have become available to staff. This has allowed staff to obtain necessary verifications in a more efficient and timely manner. All systems require specific password permission for access.

 

R-3710 Automated Status Verification Index

Revision 12-2; Effective June 1, 2012

 

The Automated Status Verification Index (ASVI) is a Department of Homeland Security (DHS) online system used to verify immigration status of non-citizens applying for benefits. The system is accessed through UNISCOPE EMULATION. Information is obtained using the individual's Alien Registration Number. Result response time is generally immediate.

If the Alien Registration Number is found by the system, the following information will be displayed:

  • Alien number
  • Last name
  • First name
  • Middle name
  • Date of birth
  • Country of birth
  • Alternate ID
  • Social Security number
  • Date of entry
  • USCIS (formerly INS) status
  • Verification number

Residency status is reported with one of the following messages:

  • Lawful Permanent Resident/Employment Authorized
  • Institute Secondary Verification
  • Temporary Resident/Temporary Employment Authorized

Refer to Section D-8000, Alien Status, for additional policy and verification information.

A user guide, ASVI/SAVE System, contains detailed information regarding access and data interpretation. The guides are available through unit supervisors.

 

R-3720 Texas Workforce Commission

Revision 12-2; Effective June 1, 2012

 

A person who loses employment may be entitled to unemployment benefits through the Texas Workforce Commission (TWC). TWC information is obtained through a Data Broker report. The Data Broker report will verify quarterly earnings and unemployment benefits. Information is obtained using the person's name and Social Security number. A match will result if the person has applied, is receiving or has received unemployment benefits with TWC.

A match by name will provide: the person's name, alias name, address, telephone number, Social Security number and date of birth. After a positive name search, the person's Social Security number may be used to verify the TWC records.

Available information includes:

  • if the person has applied for benefits;
  • wages the person earned (per quarter) during the past 24 months;
  • the status of a current claim; and
  • the amount of weekly unemployment benefits, deductions and payment dates.

 

R-3730 State Online Query/Wire Third Party Query

Revision 12-2; Effective June 1, 2012

 

State Online Query (SOLQ) is a Social Security Administration (SSA) automated system used to verify Social Security and Supplemental Security Income (SSI) benefits. The system is Windows-based. It uses the individual's name, Social Security number (SSN) or Social Security claim number (SSCN) and date of birth to identify and provide the appropriate records. When an inquiry match occurs, the response provides all available benefit information attributable to a particular claim number. SOLQ responses are not to be printed. SOLQ responses provide current information and are available immediately after request in the system.

If the individual has entitlement under more than one SSCN, those numbers will be identified. You must submit separate inquiries to obtain data related to those claims.

Information includes:

  • Standard Response — individual name, date of birth, verified SSN and error messages regarding any discrepancies between inquiry and response match.
  • Title II (RSDI) — individual demographics, enrollment in Medicare Part A and/or Part B, supplementary medical income benefits (SMIB) premium deduction, benefit amounts and dates, unearned income, disability onset dates, etc.
  • Title XVI (SSI) — individual demographics, Medicaid, SSI payment history, benefit amount, payment status code, resource and earned income leads, etc.

Note: The SOLQ system is available only in TIERS. The response only includes information for individuals in TIERS.

If more detailed information is needed, it is recommended to request a WTPY.

Wire Third Party Query (WTPY) is an SSA automated overnight batch process system used to verify Social Security and SSI benefits. Information is obtained using the person's name, SSN or SSCN, and date of birth. Response is usually received on the next business day following transmittal of the inquiry, provided the request is transmitted by 2:30 p.m. If the request is transmitted after that time, the response will be delayed one day.

If an inquiry match occurs, the response will provide all available benefit information attributable to a particular claim number. If a person has entitlement under more than one SSCN, those numbers will be identified. Separate inquiries are not necessary. The programming logic within the WTPY system will do an automated request within three business days on the newly discovered SSCNs. Staff do not have to create additional requests to obtain data related to those claims.

Information will include:

  • Standard Response — Name, date of birth, verified SSN and error messages regarding any discrepancies between inquiry and response match.
  • Title II (RSDI) — Demographics, enrollment in Medicare Part A and/or Part B, SMIB premium deduction, benefit amounts and dates, unearned income, disability onset dates, etc.
  • Title XVI (SSI) — Demographics, Medicaid, SSI payment history, benefit amount, payment status code, resource and earned income leads, etc.
  • 40 Quarters — Used for legal permanent residents, their spouses or parents. Response will provide employment history, identify the qualifying quarters and give the type income received during that period. Note: Response time for this data is within two days of transmittal (rather than one day as with other WTPY information).
  • Citizenship Verification — Effective Feb. 1, 2011. WTPY makes citizenship verification available, and is available for use by HHSC to verify citizenship for Texas Works and MEPD applicants.

The Wire Third Party Query User Guide contains detailed information regarding data interpretation. The 40 Quarters Operations Guide and 40 Quarters Response contain information outlining inquiry and response interpretation of 40 Quarters data.

Reminder: Federal tax information is provided through SOLQ and WTPY. Federal tax information is confidential. It is not to be shared with unauthorized individuals. SOLQ and WTPY responses should not be printed.

 

R-3740 Asset Verification System (AVS)

Revision 18-2; Effective June 1, 2018

The Asset Verification System (AVS) is an automated system used to request information from banking institutions on people applying for certain MEPD programs. The AVS is available through the Data Broker system and is accessed through TIERS. Use a person’s name and Social Security number  to identify and provide information on the appropriate financial records.

AVS information must be requested for the following MEPD programs at application, renewal, add a person, and program transfer requests only when consent is provided:

  • State Group Home (TA 12 ME);
  • State Supported Living Center (TP 10 ME);
  • Non-State Group Home (TP 15 ME);
  • State Hospital (TP 16 ME);
  • Nursing Facility (TP 17 ME);
  • Waiver Program (TA 10 ME);
  • Program of All-Inclusive Care for the Elderly (PACE) (TA 10 ME);
  • Pickle (TP 03 ME);
  • Disabled Adult Child (TP 18 ME);
  • Disabled Widow(er) (TP 21 ME);
  • Early Aged Widow(er) (TP 22 ME); and
  • Medicaid Buy-In (MBI) Program (TP 87 ME).

 

R-3741 AVS Consent

Revision 18-2; Effective June 1, 2018

Consent to access AVS is required for a person whose assets are considered in the eligibility determination for AVS applicable MEPD Programs.  Individuals who must provide consent are:

  • the applicant or recipient (or the individual’s legal guardian, power of attorney, or authorized representative);
  • parents whose resources are deemed to a minor child;
  • a spouse whose resources are deemed to the applicant or recipient; or
  • the community spouse for spousal impoverishment cases. 

A person provides consent by submitting a signed application or renewal form that contains the asset verification consent language. If the application or renewal form does not contain the AVC language, or does not contain the signature of the person whose assets are considered in the eligibility determination, staff must pend for a signed  Form H0003, Agreement to Release Your Facts.  Only request AVS information for someone who has provided consent.

Deny an applicant or recipient if consent is not provided from all people whose assets are considered in the eligibility determination or if a written request to revoke consent to access AVS is received.  Do not run AVS if consent is not provided or after a request to revoke consent is received.

 

R-3742 AVS Requests

Revision 18-2; Effective June 1, 2018

When consent is provided, run the determination to process eligibility but do not dispose the case.

  • If all eligibility requirements are met, initiate the AVS request. 
  • If a person does not meet all eligibility requirements, do not initiate the AVS request; process the denial.

For initial applications, request 60-months of AVS information.  For reapplications, annual redeterminations, and program transfers, request AVS information only for the months between the last AVS response and the current transaction.  If AVS was not previously requested, request 60-months of AVS information.

 

R-3743 AVS Responses

Revision 18-2; Effective June 1, 2018

AVS responses provide information on both disclosed and undisclosed financial accounts.

Initial AVS responses are received immediately and include information from the major banking institutions. 

In addition to the immediate initial responses, Data Broker will also provide enhanced AVS responses when financial information is identified for additional banking institutions not included in the immediate AVS response. The enhanced AVS response is available on the Data Broker report a minimum of 15 days after the initial AVS request.  Do not delay disposing the case when an enhanced AVS response is pending if all other information needed to make an eligibility determination is provided. Regardless of when the agency receives an enhanced AVS response, the response is treated as an agency reported change.

 

R-3744 Consideration of AVS Information

Revision 18-2; Effective June 1, 2018

Determine eligibility based on the AVS response received via Data Broker.

For both immediate and enhanced AVS responses, if the AVS information is consistent with the client-provided information, complete the eligibility determination.

If the AVS information is new or inconsistent, but does not affect eligibility, do not pend for verification. Enter the new information in TIERS and complete the eligibility determination.

If the AVS information is new or inconsistent and the applicant or recipient is potentially ineligible, pend the case and request verification from the applicant or recipient before completing the eligibility determination.

If the applicant or recipient fails to provide verification of new or inconsistent AVS information, enter the AVS information in the case and deny the case using the appropriate AVS denial reason code.