Due to the Discontinuance Batch not running, cases have been allowed to continue coverage past their Review Due Date. This means when the review is processed, incorrect coverage may be issued, or CE dates and Review dates may be set incorrectly.
When processing a Family Medical review that has already been allowed to roll past the Review Due date, and there are no new requests for coverage, do NOT re-run EDBC for any of the already paid months.
Process the review starting in the come-up month.
Use the RE Run Reason when running EDBC for the come-up month. This establishes a new Review Due date for the program.
Once EDBC has been ran through the come-up month and Accepted/Saved, the CE dates and the new Review Due date need to be manually updated. This is done because the ‘original’ review period should be maintained.
Example: Review Due is set to 2/2016. Due to the Discontinuance Batch not running, coverage has remained active through the current benefit month. When EDBC is run in the come-up month, the applicants receive a full new CE period. This would be incorrect, as the consumer already received “extra” months of coverage from the original review. The new CE period and Review period should be moved back to match what they would have been had the review been processed timely.
For instructions on how to edit CE dates and the Review Due date, see Updating Individual Continuous Eligibility and Review Dates.
When processing a Family Medical review that has already been allowed to roll past the Review Due date, the process below should be followed when there are new requests for coverage. This process is necessary in order to ensure benefits already paid out are not “taken away” and that CE Dates and the Review Due date are correct.
Update the CE Dates for all Active MEMs on the program who have received benefits past the Review Due date. CE Dates should be set to the last day of the current system month. For instructions on how to edit CE dates and the Review Due date, see Updating Individual Continuous Eligibility and Review Dates.
Run EDBC starting with the application month (or first prior medical month if there was a prior medical request) for the new applicant. If necessary, continue running EDBC through the current system month.
Use the RE Run Reason when running EDBC for the come-up month. This establishes a new Review Due date for the program.
Once the high-dated EDBC has been Accepted/Saved, the CE Dates and the new Review Due date should be manually updated. This is done because the ‘original’ review period should be maintained.
For instructions on how to edit CE dates and the Review Due date, see Updating Individual Continuous Eligibility and Review Dates.