|
Perceptive Content Document Type |
KDHE General Form(s) |
Task Name |
Queue |
|
AGO App |
KC-1100 Application for Medical Assistance for Families with Children |
AGO Application |
Registration |
|
AGO Unsigned App |
KC-1100 Application for Medical Assistance for Families with Children |
AGO Unsigned Application |
Registration |
|
Annuity Clearance |
Trust Documents that are for review to determine countable resources/income. |
Trust/Annuity Clearance |
Trust/Annuity |
|
Appeal |
Beneficiary Request for Medicaid Fair Hearing Any other Documents associated to a Fair Hearing |
Appeal |
Concerns |
|
Barcoded Document |
All Barcoded Forms |
Will use logic to determine the correct Queue and Task based on the Documents barcode. |
|
|
BCC Application |
ES-3100.7 Application for Medical Coverage – BCC |
BCC Application |
Specialty |
|
BCC Review |
KC-1400 Notice of Review – Medical Assistance – BCC Program |
Process BCC Review |
Specialty |
|
Concerns |
Example: KC-6501 KDHE Civil Right Complaint Any Document associated to a Complaint or Concern |
GR-Other |
Concerns |
|
Correspondence |
Example: Fax Cover Sheet KC-1105 E&D Supplement to the KC-1100 |
IROD/Incoming Documents/ Follow Up Written Correspondence |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Critical Correspondence |
Misc. (Follow Current Business/Policy Process) |
Critical Correspondence |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
E&D Accelerated App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
E&D Accelerated Application |
Registration |
|
E&D App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
E&D Application |
Registration |
|
E&D Passive Review |
KC-1700 Passive Elderly and Disabled Review |
Process Review |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
E&D Pre-Populated Review |
KC-1600 Pre-Populated Elderly and Disabled Review |
E&D Pre-Populated Review |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
E&D PW App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
E&D PW Application |
Registration |
|
E&D Urgent App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
E&D Urgent Application |
Registration |
|
E&D Unsigned App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
E&D Unsigned Application |
Registration |
|
ES-3160 KanCare HCBS Services |
ES-3160 HCBS Services |
ES-3160 HCBS Services |
LTC Eligibility |
|
ES-3161 KanCare HCBS Changes and Updates |
ES-3161 HCBS Changes and Updates |
ES-3161 HCBS Changes and Updates |
LTC Eligibility |
|
Expense |
Examples: CSS/Spousal Expense Medical Expense Health Insurance Expense |
IROD/Incoming Documents/ Follow Up Written Correspondence |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
FC Child Returning CH-App |
KC-1100 Application for Medical Assistance for Families with Children |
FC Child Returning CH-Application |
Registration |
|
FC Child Returning CH-Unsigned App |
KC-1100 Application for Medical Assistance for Families with Children |
FC Child Returning CH- Unsigned Application |
Registration |
|
Follow up written correspondence |
Misc. (Follow Current Business/Policy Process) |
Follow up Written Correspondence |
Administrative-CH |
|
Income |
Examples: Pay Stubs/Employment Verification Benefit Amount Letter SS, Retirement, Indian Monies, etc. Self-Employment Ledgers Tax Documents Oil Royalties Loans |
IROD/Incoming Documents/ Follow Up Written Correspondence |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Incoming Documents |
Uploaded Portal Documents (not to include the Document Upload Portal) |
Incoming Documents |
MAGI Eligibility LTC Eligibility E&D Eligibility Specialty |
|
Inmate Application |
ES-3100.1a Correctional Facility Inmate – Qualifying Event |
Inmate Application |
Specialty |
|
Institutional NB App |
KC-1100 Application for Medical Assistance for Families with Children |
Institutional Newborn Application |
Registration |
|
Institutional NB Unsigned App |
KC-1100 Application for Medical Assistance for Families with Children |
Institutional Newborn Unsigned Application |
Registration |
|
IROD |
Any document received for a program that was discontinued in the past 45 days Not an application, review, high priority, or specialty. |
Info Rcvd On Denied/Disc |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Journaling |
Screenshots of any electronic pages used for eligibility. |
No Task Created |
|
|
KDHE OSW Application |
KC-1100 Application for Medical Assistance for Families with Children KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
Outstationed Application Form |
Outstationed |
|
Legal |
Legal documents other than any associated to an Admin Role. |
Legal |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Legal Representative |
Examples: Facilitator Authorization Form Medical Representative Authorization Form DPAO Appointment of Authorized Agent Designated Representative Authorization Court Order Appointing Guardian and Conservator
|
Admin Role Update |
Administrative-CH |
|
LTC Accelerated App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
LTC Accelerated Application |
Registration |
|
LTC App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
LTC Application |
Registration |
|
LTC PW App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
LTC PW Application |
Registration |
|
LTC Urgent App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
LTC Urgent Application |
Registration |
|
LTC Unsigned App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
LTC Unsigned Application |
Registration |
|
MAGI Accelerated App |
KC-1100 Application for Medical Assistance for Families with Children |
MAGI Accelerated Application |
Registration |
|
MAGI App |
KC-1100 Application for Medical Assistance for Families with Children |
MAGI Application |
Registration |
|
MAGI Passive Review |
KC-1300 Passive Family Medical Review |
Process MAGI Passive Review |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
MAGI Pre-Populated Review |
KC-1200 Pre-Populated Family Medical Review |
MAGI Pre-Populated Review |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
MAGI PW App |
KC-1100 Application for Medical Assistance for Families with Children |
MAGI PW Application |
Registration |
|
MAGI Urgent App |
KC-1100 Application for Medical Assistance for Families with Children |
MAGI Urgent Application |
Registration |
|
MAGI Unsigned App |
KC-1100 Application for Medical Assistance for Families with Children |
MAGI Unsigned Application |
Registration |
|
Medical Provider Document |
Uploaded via the Document Upload Portal |
Uploaded Medical Provider Document |
Medical Provider Docs |
|
Medically Needy App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
Medically Needy Application
|
Registration |
|
Medically Needy Unsigned App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
Medically Needy Unsigned Application
|
Registration |
|
MS-2126 Facility Admission/Discharge |
MS-2126 Facility Admission/Discharge |
MS-2126 Facility Admission/Discharge
|
LTC Eligibility |
|
MSP App |
ES-3100.8 Medicare Savings Program Application |
MSP Application
|
Registration |
|
MSP Unsigned App |
ES-3100.8 Medicare Savings Program Application |
MSP Unsigned Application
|
Registration |
|
Passive Review Letter |
KC-1700 Passive E&D Review |
Passive Review Response
|
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Personal Identifying Information |
Examples: Photo ID, SSN, Birth Certificate, Shot Record, Alias Name P-7 Declaration of Identity P-8 Third party – Declaration of Citizenship P-9 Declaration of Identity – Disable Adult Marriage License Death Certificate |
IROD/Written Correspondence/Incoming Documents |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
PE Tool |
Presumptive Eligibility Approval/Denial Letter Presumptive Eligibility Application PDF *Only used outside of the normal PE Process |
NA |
NA |
|
PII-Newborn |
KC-1100 Application for Medical Assistance for Families with Children |
PII-Newborn |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Pre-Release Application |
ES-3100.1a Correctional Facility Inmate – Qualifying Event |
Pre-Release Application
|
Specialty |
|
Release of Info |
Examples: ES-3101 Release of Information and Liability ES-3904 HIPAA Complaint Auth to Release Info to KHPA DD-1103 Auth to Release Medical Information ES |
Admin Role Update |
Administrative-CH |
|
Resources |
Examples: Bank Statement Land/Parcel Deed Life Insurance Pre-Paid Burial Agreements Property Valuations |
IROD/Written Correspondence/Incoming Documents |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
Returned Mail-In State |
Any Returned Mail with a forwarding Address Listed in Kansas |
Returned Mail - In State
|
Contact Updates
|
|
Returned Mail-No Fwd. Address |
Any Returned mail with no Forwarding Address Listed |
Returned Mail - No Fwd
|
Contact Updates
|
|
Returned Mail-Out of State |
Any Returned Mail and Forwarding Address is Listed as Out of State |
End Coverage – Program |
Contact Updates
|
|
Returned Mail-PR Letter |
KC-1300 Passive Family Medical Review KC-1700 Passive Elderly and Disabled Review |
End Coverage – Program |
Contact Updates
|
|
SOBRA E&D App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
SOBRA E&D Unsigned Application |
Registration |
|
SOBRA E&D Unsigned App |
KC-1500 Application for Medical Assistance for the Elderly and Persons with Disabilities |
SOBRA E&D Unsigned Application |
Registration |
|
SOBRA MAGI App |
KC-1100 Application for Medical Assistance for Families with Children |
SOBRA MAGI Application |
Registration |
|
SOBRA MAGI Unsigned |
KC-1100 Application for Medical Assistance for Families with Children |
SOBRA MAGI Unsigned Application
|
Registration |
|
Spousal Improvishment |
Examples: ES-3162 Designation of Community Spouse ES-3163 Resource Assessment and Allowance Determination M-2 Notice of Intent to Transfer Resources M-3 Notice of Intent to Allocate Income M-4 Spousal Impoverishment Allowance Memorandum |
IROD/Follow Up Written Correspondence/Incoming Documents |
MAGI Eligibility LTC Eligibility E&D Eligibility |
|
SSP Uploaded Documents |
All documents uploaded through the SSP |
|
|
|
TB Application |
3100.3 Certification of Need for Tuberculosis Treatment |
TB Application |
Specialty |
|
Trust/Annuity Clearance |
Example: B-6 Request for Trust/Annuity Clearance |
Trust/Annuity Clearance |
Trust/Annuity |
|
Unsigned CH Review |
KC-1300 Passive Family Medical Review KC-1700 Passive Elderly and Disabled Review |
Unsigned Review |
Registration |
|
Urgent ES-3160 HCBS Services |
ES-3160 HCBS Services |
ES-3160 HCBS Services |
LTC Eligibility |
|
Urgent ES-3161 HCBS Changes and Updates |
ES-3161 HCBS Changes and Updates |
ES-3161 HCBS Changes and Updates |
LTC Eligibility |
|
Urgent MS-2126 Facility Admission/Discharge |
MS-2126 Facility Admission/Discharge |
MS-2126 Facility Admission/Discharge |
LTC Eligibility |
|
Working Healthy 6 Month Review |
N-812 Working Healthy – Six Month Review |
WH-Review Registration |
Registration |