Working Healthy Recipient Request To Add WORK/WORK Case Maintenance

 

This WA should be used anytime staff are running EDBC to add WORK to already existing Working Healthy coverage. This WA should also be used anytime EDBC needs to be ran after the initial WORK coverage has been established.

  1. Navigate to the Run EDBC screen.

    1. Select the benefit month that the consumer is eligible for WORK

    2. Click Run EDBC

    3. On the EDBC List page select the Medical hyperlink with the Run Status Not Accepted

  2. In the Medical EDBC Summary screen, click the Override Medical Summary button

  3. In the Medical EDBC Override List screen, click the Override button for the Working Healthy program.

  4. In the Medical Override Detail screen, click Add in the LTC Details.

  5. In the Medical EDBC LTC Override Detail screen, complete the following fields:

    1. Override Applies to: Beneficiary’s name

    2. LTC Type: WORK

    3. Living Arrangement:  WK

    4. Level of Care:  N/A

    5. Start Date:  The date the consumer is eligible for coverage

    6. Liability:  Enter ‘0’

    7. Resource:  Enter ‘123456’

    8. Click Save and Return

  6. In the Medical Override Detail Screen, complete the following fields:

    1. Start Date:  Enter the first day of the benefit month

    2. End Date:  Enter the last day of the benefit month

    3. Click Save and Return

  7. In the Medical EDBC Override List screen, check the box next to the overridden EDBC

    1. Select Administrative decision for the EDBC Override Reason

    2. Staff will need to check the overridden test record to ensure it its correct

    3. Click Save and Return

  8. In the Medical EDBC Summary screen, click Accept if the EDBC Result is correct.

  9. In the EDBC List screen, click Save and Continue.

  10. Send Notices. See Manual NOA Generation for detailed steps on sending the notifications.

  11. Create a Journal entry documenting the changes.