Benefit Eligibility System and Medical Assistance Program

The Vendor is required to provide for benefit eligibility system and medical assistance program.
- Case Processing and Eligibility Determination
• ESs manually enter the information from the paper applications into agency. Agency is the system of record for eligibility processing and case management.
• ESs verify information, apply eligibility policy, and document completeness of application materials in the system.
• ESs document case activity, outstanding items, and next steps using a standard process and Microsoft Excel spreadsheet called a “Case Tracking Log” that supports visibility and follow-up actions.
• If an ES finds that an application is missing information or documentation was incorrectly completed, they file a request for information through agency, which creates an official notice that the ES sends to the applicant via email, phone and/or mail.
• Once an application is complete, ESs flag the case in their Case Tracking Log to notify the supervisor that the documentation is ready for review.
- Supervisors also conduct biweekly QC meetings to review case examples, clarify documentation and policy expectations, and identify recurring issues that require correction or additional guidance.