CLAIMS HANDBOOK - Department of Human Services
CLAIMS HANDBOOK - Department of Human Services
CLAIMS HANDBOOK - Department of Human Services
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BENEFIT RECOVERY (<strong>CLAIMS</strong>) <strong>HANDBOOK</strong><br />
Overview <strong>of</strong> Benefit Recovery<br />
Benefit errors occur when an Assistance Unit (AU) receives an incorrect benefit amount<br />
in the Food Stamp, Temporary Assistance for Needy Families, Child Care or Refugee<br />
Assistance Program.<br />
Federal and State regulations provide for the mandated recovery <strong>of</strong> over-issued benefits or the<br />
restoration <strong>of</strong> under-issued benefits.<br />
Benefit errors are generally caused by:<br />
• A customer unintentionally providing inaccurate or incomplete information<br />
• A customer deliberately providing incomplete or inaccurate information<br />
• A case manager failing to take action on known information<br />
• A case manager miscalculating benefit entitlement<br />
In the programs supported by SUCCESS, errors must be corrected by:<br />
• Invalidating the benefit error if unsupported by verification, case<br />
documentation, policy or if it meets fiscal criteria<br />
• Validating the error by issuing an underpayment (UP) or establishing a claim<br />
• Referring the suspected program violation to the Office <strong>of</strong> Program Integrity and<br />
Compliance (OPIC)<br />
The Office <strong>of</strong> Family Independence Policy Manual provides policy to determine the validity<br />
<strong>of</strong> benefit errors.<br />
The Benefit Recovery portion <strong>of</strong> the Office <strong>of</strong> Family Independence Policy Manual (Volume<br />
IV) is a specific guide to the management <strong>of</strong> benefit errors.<br />
The SUCCESS User Manual provides instructions for the automated tracking and reporting <strong>of</strong><br />
benefit errors and recoveries.<br />
The Field Fiscal <strong>Services</strong> Policy and Procedures Manual provides guidelines for managing<br />
the recovery <strong>of</strong> and ensuring the fiscal integrity <strong>of</strong> recovered funds in the county.<br />
The Claims Handbook provides the County and State with established procedures for claims<br />
management.<br />
Claims management includes monitoring the management reports produced by SUCCESS as<br />
well as claims file maintenance and customer service to those whose claims we manage. It<br />
also includes working with state and other county personnel to assure that we recover all that<br />
is due but no more, and that we complete this task while allowing the debtor to maintain<br />
dignity.<br />
Rev December ‘10 5