When the consumer Fails to Provide the requested verification, a denial and or discontinuance must occur.
On a New/New case- a user needs to deny any/all consumers who have applied, but who have not received coverage.
Click the Non-Compliance hyperlink from Task Navigation. The Eligibility Non-Compliance List page displays.
Click the Add button. The Eligibility Non-Compliance Detail page displays.
Update the following fields:
Name: Choose the consumer you are setting the Non-Compliance record
Type: Failure to Provide
Reason: Information needed for Medical Eligibility
Begin Date: First date of application month
Click the Save and Add Another button to add additional records. Otherwise, click the Save and Return button.
Click the Run EDBC hyperlink from Task Navigation.
Run and Accept the denial for any months that need denied.
Set the verification record that was not provided to Refused.
Set the Non-Compliance record for the consumer who had received the Partial Approval determination and Run EDBC for that month.
All consumers should be denied/discontinued at this point.
NOTE: For an already active case, a user should follow the Eligibility Non-Compliance process.
* Please follow the verification status below based on the situation. *
Verification status of ‘Refused’ should be used when the consumer fails to provide information needed for a medical determination.
Verification status of ‘Pending’ should be used when the consumer is not categorically eligible for any KanCare program.
Verification status of ‘Not Applicable’ should be used when a consumer fails to provide information needed for a prior medical determination, but the information for the application month is verified.
Verification status of ‘Refused’ or ‘Pending’ that was used previously and not needed for the current medical determination, keep the verification status the same.