CLAIMS HANDBOOK - Department of Human Services
CLAIMS HANDBOOK - Department of Human Services
CLAIMS HANDBOOK - Department of Human Services
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(If customer has a valid SSN)<br />
BENEFIT RECOVERY (<strong>CLAIMS</strong>) <strong>HANDBOOK</strong><br />
ALL procedures must be entered the same day<br />
1. Change AU member’s status from SE to OR.<br />
2. Change another AU member’s status to SE.<br />
3. Take the above procedures through DONE.<br />
4. Deny OR using reason 512 (ongoing and historically for the months you want<br />
individual disqualified- you will have to go back 1 month prior to the first month the<br />
individual will be disqualified because when you add-a-person the individual will be added<br />
for the first month with a reason “337” and will not be disqualified that month) – go through<br />
DONE.<br />
5. Do Add-A-Person for OR, changing individual’s citizenship to a citizen code – go<br />
through O, P, Q.<br />
6. Change the status <strong>of</strong> the AU members previously changed in steps 1 and 2, back to<br />
the original status – go through DONE.<br />
7. Impose disqualification on DEM3.<br />
8. Enter disqualification into DRS unless the customer does not have a social security<br />
number.<br />
9. DO NOT change the codes back to the original non-citizenship codes until the entire<br />
period <strong>of</strong> disqualification has been served by the AU member. Changing the codes<br />
prematurely will affect the budgeting and the customer will receive erroneous<br />
benefits.<br />
To correct erroneous disqualification data on STAT:<br />
1. Access STAT screen – change SA to PN.<br />
2. Remove the reason code.<br />
3. Shorten the penalty period by changing the end date to a date prior to the first day<br />
<strong>of</strong> the penalty period.<br />
4. Access DEM3 and correct the counter #.<br />
5. Access MISC and enter “Y” under cal. elig.<br />
6. Go through DONE.<br />
To remove a disqualification from SUCCESS at the end <strong>of</strong> the disqualification period:<br />
1. Access STAT Screen during final month <strong>of</strong> DQ period – Change SA to PN<br />
2. Remove the reason code.. The penalty end date should be last day <strong>of</strong> the current<br />
month<br />
3. Access DEM3. Verify that the effective date is correct or delete data<br />
4. Go through DONE<br />
Rev December ‘10 45