Home > KEES User Manual Introduction > Family Medical > Partial Approval - Family Medical
See also:
Deny or Discontinue a Partial Approval
Partial RCD Approval with Pending Verification
This process is used when one or more consumer’s coverage is determined before all other consumers on the case have their eligibility determined. Examples of this include accelerated or urgent need cases.
The following process is followed at the time of the first determination.
Fill out all data collection pages that information is available for.
Navigate to the Individual Demographics page. Click the Edit button next to a consumer who is requesting coverage but who will not be approved in the partial approval. The Individual Demographics Detail page displays.
Note the consumer’s SSN status.
Update the SSN Status drop-down menu to SSN Provided and click the Save and Return button. The Individual Demographics List page displays.
Repeat Steps 2, 3, and 4 for each person who will not be approved in the partial approval.
Click the Run EDBC link from the Task Navigation Bar. The Run EDBC page displays.
Select the medical program you want to determine eligibility for. Click the Run EDBC button. The EDBC List page displays.
Click the hyperlink for the medical program. The Medical EDBC Summary page displays. If correct eligibility displays for the individual receiving the determination, click the Accept button. The EDBC List page displays.
NOTE: The consumer(s) whose SSN status has been modified will display as a FRI with a Role Reason of Pending SSN Verif; and will have a Y display under the QHP Screened header.
Click the Save and Continue button. The Distributed Documents Search page displays.
Review the NOA for accuracy. The following phrase, which can be found on the "Standard Text for Copy and Paste" document must be added to the Append section of the NOA.
“The medical determination for [insert name of consumer still pending] could not be completed at this time. If further information is needed, a separate letter is sent to you.”
Once the NOA is complete, click the Save and Print Centrally button. A NOA confirmation page displays.
Click on Individual Demographics from Task Navigation. The Individual Demographics List page displays. Click the Edit button next to the consumer whose SSN status was modified. The Individual Demographics Detail page displays.
Update the SSN Status back to Good Cause. Click the Save and Return button.
NOTE: The Case Summary page will now show the consumer who was approved with a Role of MEM and a Status of Active and the consumer who has not yet been approved with a Role of FRI and a Role Reason of Pending SSN Verif.
Send a verification request notice using instructions and approved fragments in the "Standard Text for Copy and Paste" document. This verification request will include all information needed for any persons not yet determined as well as information needed to finalize an expedited pregnant woman.
NOTE: If determining eligibility for an “expedited pregnant woman” on an already Active program; leave the Income verification as Pending for the initial month and then change the Income verification to Verified on the second month to get current eligibility. Once the notice is created; go back and update the status of the Income to Pending and send the request for verification form. This process is necessary as workers normally process two months of expedited coverage to bring the case to the come-up month at initial determination.
In the Journal entry created for the Partial Approval, staff must note that the SSN verification status was updated form its original status to SSN Provided and then to Good Cause in order to complete the case. The Journal entry should note specifically the individual(s) this was done for.
Example details to include in the Journal entry:
Completed partial approval for CH 1 and CH 2. Updated their SSN verification status from HUB-SSA to SSN Provided then to Good Cause to complete the partial approval process.