RE Run Reason Validation without an Available RE Run Reason
Follow these steps if the Review and IR/12 Month record did not update to Complete-EDBC Accepted after running EDBC.
Select Eligibility from Global Navigation. Select Reporting from Local Navigation. The Review and IR/12 Month Reporting List page displays.
Click the Edit button. The Review and IR/12 Month Reporting Detail page displays.
Select Complete-EDBC Accepted from the Report Status drop-down menu.
This process is to be used when a review application is received and other household members are requesting current coverage. This would apply to reviews that were extended past their review date due to the discontinuance batch not running timely. Running EDBC in the month of application through review month gives correct coverage. Running EDBC for the month after review could result in a “Read Only” EDBC, an incorrect denial or changing of coverage in paid months. To prevent this from happening complete the steps below.
Example: Processing a review application on 02/04/2016. Application received on 11/20/2015. Review is for 3 children. Application is also requesting current coverage for Mom. Review was due in 12/2015, but coverage for the 3 children has been paid through 02/29/2016 due to the discontinuance batch not being run yet. Mom is pending in months 11/2015-03/2016. CE Dates for the 3 children will need to be updated to reflect 02/29/2016 in order to protect the paid coverage for the 3 children. If processing the review and coverage changes, the change shall be effective 3/1/2016. If the change causes a reduction in premium, the premium shall be reduced in the month following the month of report. In this case, the premium would be reduced in December 2015.
Navigate to Case Summary page in KEES.
Click View Details on the program block corresponding to the review app being processed. The Medical Program Detail page displays.
Click the Edit button.
Locate household members with review due in the Program Persons block and click the Edit button.
Locate CE period ending with current review due in the Continuous Eligibility Periods block and click the Edit button.
Example: Review due is 12/2015, CE period would end in 12/2015.
Update the End Month field to the date to the last day of the most recent PAID month using the <mm/dd/yyyy> format or the calendar icon.
Example: The most recent paid month is 02/2016, End Month should be 02/29/2016.
Click the Save and Return button.
Repeat these steps for all household members with a review due. Once complete all members updated show a Continuous Eligibility result in EDBC for all paid months.
This does not change the household review period. After EDBC has been accepted for all months CE dates may need to be updated to reflect correct review period. If not eligible in the come-up month, then it would be appropriate to discontinue coverage, allowing for timely notice.
NOTE: Do not forget to update the Review and IR records to correctly identify that the review has been processed.