OBSOLETE POLICY CHIP MANUAL |
Effective Date: August 1, 2011
The Department and the eligibility agency conducts reviews of medical assistance cases to determine the accuracy and quality of eligibility decisions made by the eligibility agency, and the accuracy of payments made by the Department.
Applicants and enrollees of medical assistance are required to cooperate with the Department and the eligibility agency to complete these quality reviews.
The Department may contact an applicant or enrollee as part of a quality review.
The applicant or enrollee is required to provide complete and accurate information about factors related to the client's application or eligibility to the Department and the eligibility agency.
Clients are required to answer questions the Department or eligibility agency asks about factors related to the client's eligibility and medical services the client received.
The Department or eligibility agency may ask the applicant or enrollee to provide verifications of the information being reviewed. The applicant or enrollee must provide any requested information to the Department or eligibility agency, as applicable, within 10 days of the request.
Failure to cooperate with the quality review will result in a closure of the enrollee's medical assistance.