CLAIMS HANDBOOK - Department of Human Services

BENEFIT RECOVERY (CLAIMS) HANDBOOK
When OPIC completes the investigation, a disposition packet will be forwarded to the
county with an explanation of the findings and instructions regarding disqualification. Upon
receipt of the disposition letter:
1. Annotate, on the Referral Log, the date of receipt of the disposition letter from
OPIC and the action taken.
2. Check the claim type and status to ensure the claim type has been changed
from “S” and the claim status is no longer PS.
3. Access DEM3 for the active disqualified individual, enter the disqualification
type, counter and effective date per TANF and FS policy. The STAT screen
will be updated from DEM3.
4. Use the SSN of the FS disqualified individual to access and enter the
required information onto DRS. The disqualification information does not prepopulate
from DEM3 to DRS.
SUCCESS Disqualification Procedures (DEM3)
Only one IPV disqualification per program should exist on DEM3. Disqualification data on
DEM3 should be deleted when the period of disqualification ends or replaced with data for
subsequent disquaifications. IPV disqualification overrides any other type of ineligibility.
Income and expenses of an IPV disqualified AU member are not prorated or
excluded.
To impose disqualification on DEM3:
1. Enter disqualification type – there are only two valid disqualification codes. IPV
and trafficking disqualifications are coded as type “I” and disqualifications due to
customer receiving benefits in multiple states at the same time are coded type
“M”. Entering type “M” will result in an “Out of Sync” alert being generated.
Document and proceed.
2. Enter counter #.
3. Enter effective date of disqualification per TANF and FS policy, the STAT screen
will be updated from DEM3.
4. Document circumstances of disqualification on remarks screen.
Concurrent disqualifications may occur in the FS Program. A subsequent disqualification
replaces the current one with overlapping disqualification period being served concurrently.
To enter a concurrent disqualification:
1. Enter the concurrent disqualification into DRS as usual.
2. Change the financial responsibility code on STAT to PN.
3. Change the disqualification end date to the end of the current month.
4. Proceed to DEM3 and type over the existing disqualification data.
5. When eligibility is confirmed, the correct data will appear on the STAT screen.
To make ineligible alien/student eligible so as to impose disqualification:
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