63. IEVS Unit Workflows...page 63-2 Common Place 63. IEVS Unit Workflows Page 63-2 Update #18-03•...

Medi-CalCommon Place 63. IEVS Unit Workflows

63. IEVS Unit Workflows

63.1 Overview

The Income and Eligibility Verification System (IEVS) IEVS Unit is one of the specialized units under the Administrative Support Bureau (ASB). The IEVS Eligibility Examiners (EEs) are responsible for determining and computing overpayments from the following:

• Integrated Fraud Detection (IFD)/Earning Clearance System (ECS) Match• Asset Match - Franchise Tax Board (FTB)• Asset Match - Internal Revenue Service (IRS)• Beneficiary Earnings Exchange Record (BEER)• General Fraud referrals from the Special Investigations Unit (SIU)• Intentional Program Violation (IPV) referrals from SIU• In-Home Supportive Services (IHSS) Provider List

The EEs are also responsible for gathering data for Child Support Defaults and Trial cases.

This Chapter discusses the workflow that applies to the IEVS Unit only.

63.2 IFD 440 CalWIN Interface Quarterly Report Review

The Interfaces Quarterly IFD 440 reports are generated on-line through CalWIN. This subsection outlines the process when the IFD 440 is received by the IEVS Unit. Some of the terminologies include:

• Reading - Eligibility Examiners complete a brief review to determine if the IFD 440 abstract is considered discrepant or non-discrepant and the next steps required in the review process.

• Discrepant (D) - Client did not report the earnings reported on the IFD 440 and the Eligibility Worker (EW) has not recorded the earnings in CalWIN.

• Non-Discrepant (ND) - Client reported the earnings reported on the IFD 440 and the EW has completed the processing of the earnings.

• Discrepant/Completed (DC) - A discrepancy was found and the EW processed the earnings and established an overpayment. For these instances, clerical staff open the case to enter the information in SCCIEVS and close it immediately after.

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2Common Place 63. IEVS Unit Workflows

• Discrepant/1604 (D-1604) - Client reported the earnings on the IFD 440 timely, but the EW did not budget the earnings on an active case. A request will be made via “IEVS Communication” (SCD 1604) to process overpayments.

63.2.1 IFD 440 Reading Workflow

The following process must be followed for IFD readings:

Step Who Action

1. Information Systems

• Extracts the IFD 440 reports and applies filter(s) to develop a list of cases for EE review.

• Uploads assignments to the SCCIEVS application.

• Notifies the Management Analyst.

2. IEVS Supervisor

Verifies that SNAP schedule is updated prior to SCCIEVS upload.

3. Eligibility Examiner (EE)

• Receives auto-assignment of IFD 440 abstracts for reading in SCCIEVS application.

• Reviews cases and determines if D, ND, DC or D - 1604.

• Indicates status in CalWIN & SCCIEVS.



4. If... Then EE...

D, • Documents the following in the Maintain Case Comments window in CalWIN:• Calendar quarter being reviewed,• Reason for potential discrepancy, and• Other quarters open for review, if any.

• Updates Reading Status field to Discrepant in SCCIEVS.

• Generates first client letter in SCCIEVS Note:

A TMT will be auto-generate for the district office EW to follow-up on current income.

ND, • Updates Reading Status field to Non-Discrepant in SCCIEVS.

Note:Update in SCCIEVS will trigger an update to the Create IEVS IFD Response Document and an auto-generated comment in the Maintain Case Comments window in CalWIN

• Adds details in CalWIN case comments as appropriate.

DC • Updates Reading Status field to Discrepant-Completed.

• Updates the Create IEVS IFD Response Document and records claim amounts in CalWIN.

D - 1604 • Completes the SCD 1604if the benefits case is active and OP is due to Administrative Error.

• Emails SCD 1604 to the IEVS Verification Desk inbox for TMT creation.

• Updates CalWIN case comments.

5. EE Lead/ Supervisor

Monitors and ensures daily readings are processed.



6. Clerical • Monitors that readings in DC status are completed and enters claim information in SCCIEVS.

• Completes SCD 1604s for readings in D-1604 status. [Refer to “Compliance Desk Process,” page 63-19].

• Creates IEVS Working folder when any correspondence is received.

• Monitors “Client Letter” (SCD 1511-CL) and “Employer Letter” (SCD 1511-EL).

Calendar Days 1-11

If the client.... Then...

Returns the SCD1511-CL with complete verifications,

• Enters receipt in SCCIEVS.

• Files letter and verification in the IEVS working folder.

• Waits for Employer Letter.

Returns the SCD1511-CL but additional verification is needed, or

Did not return the SCD 1511-CL,

• Documents in SCCIEVS when incomplete verifications are received.

NOTE: The “First Employer Letter” (SCD 1511-EL1) is automatically generated in SCCIEVS on the 11th working day following the SCD 1511-CL.

Calendar Days 12-23

If the employer.... Then...

Returns SCD 1511-EL1 with complete verifications,



• Changes case status to Ready for Assignment in SCCIEVS.

Returns the SCD 1511-EL1 but addi-tional verification is needed, or

Did not return the SCD 1511-EL1,


• Generates “Second Employer Letter” (SCD 1511-EL2) in SCCIEVS and mails to employer(s).

Calendar Days 24-33


Returns the SCD 1511-EL2 with com-plete verifications,



• Updates case status to Ready for Assignment in SCCIEVS.

Returns the SCD 1511-EL2 but additional verification is needed, or



• Mails “Final Employer Letter” to the employer(s).



7. Calendar Days 34-43


Returns “Final Employer Letter” (SCD 1511-EL3) with complete verifications,



• Updates case status to Ready for Assignment in SCCIEVS.

Returns the SCD 1511-EL3 but additional verification is needed, or


Assigns case to EE lead as a “Verification Desk Closing”.

8. EE • Receives IEVS case folder from Assignment Desk.

• Follows Benefit Calculation Process. [See “Benefit Calculation Process,” page 63-6.]



63.3 Benefit Calculation Process

The following is the Overpayment (OP) computation chart to be processed by the EE or EW:

If... And... Then...

CalWIN has an “Open” case status,

Cash Aid and/or CalFresh program is “Open” with an Administrative Error identified in the first quarter,

District office case carrying EW will compute the OP.

Cash and/or CalFresh program is “Open” with Client Error,

IEVS EE will compute the OP.

CalWIN has a “Closed” case sta-tus,

Either Client or Administrative Error, IEVS EE will compute the OP.

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The table below outlines the steps when calculating OP:

Steps Who Actions

1. EE • Receives IEVS working folder from clerical.

• Conducts review to assess if there is sufficient documentation to complete a computation.

If the documentation in the IEVS case is...

Then...

Sufficient, Continues with processing the OP.

Not sufficient, • Determines if additional verifications are needed and attempts to obtain necessary information by any means available.

• Updates Case Status field in SCCIEVS to Pending Verification and follows up within 30 days of request.

• Documents reason on the Maintain Case Comments window in CalWIN.

• Updates the Status field to Processed, No Discrepancy on the Create IEVS IFD Response Document in CalWIN.

• Updates Case Status field to Simple Close and selects a Close Reason in SCCIEVS after 30 days of request.

• Determines, based on the CalWIN case status, if IEVS case will be ready for computation. If the case is at intake, waits for intake disposition before performing computation.

NOTE: Consult with supervisor if guidance is needed to determine if information on file is sufficient for computation.

2. IEVS Supervisor

Reviews a sample of simple close cases from EEs.



3. EE • Once required verifications are received, begins OP computation either manually or in CalWIN.

• Records manually-computed overpayments (OPs) in Non-System Determined Claim window or establishes OP in CalWIN. NOTE: In order for the OP claim to be captured on the IEVS Management Report (DPA 482), the EE MUST select IEVS-IFD Reports from the Discovery Source drop down field in the Create/Revise Non-System Determined Claim window.

• Documents case completion in CalWIN.

• Completes “Overpayment Worksheet” (SCD 11).

• Refers case to SIU via CalWIN.

If the OP amount is... Then...

$3,000 or over, Submits working folder to IEVS Supervisor for review.

Under $3,000, Submits IEVS working folder to clerical for scanning in IDM.

• Adds claim number, claim amount and claim reason to SCCIEVS.

• Updates the Case Status to Completed in SCCIEVS.

4. IEVS Supervisor

• Reviews the following on all cases over $3000 and a sample of assignments under $3000:

• Completed assignments and validates closings.

• Benefit calculation accuracy and NOAs.

• Submits IEVS working folder to clerical for scanning in IDM for cases over $3000.

5. Clerical • Scans case information into IDM.

• Returns folders with OI/OPs over $3,000 to IEVS Supervisor.

6. IEVS Supervisor

Forwards physical case folders with OI/OPs over $3,000 to SIU. [Refer to “General Fraud,” page 63-16]

Steps Who Actions



63.4 Beneficiary Earnings Exchange Record (BEER) Internal Revenue Service (IRS) Asset Match Franchise Tax Board (FTB) Asset Match

This subsection outlines the processes when records are received from the Internal Revenue Services (IRS) and Franchise Tax Board (FTB).

Reminder:

The BEER and IRS Asset Match records utilize federal wage and benefit information. Accessing federal wage and benefit information requires adherence to federal data security guidelines. EEs must ensure that the processes outlined in Santa Clara’s Safeguard Activity Report are being followed when a BEER or IRS Asset Match case is received.

Step Who Actions

1. State/Feds • Forwards hard copies of the BEER/IRS Asset Match/FTB Asset Match abstracts with rosters.

2. IEVS Supervisor

• Receives BEER/IRS Asset Match/FTB Asset Match from State/Feds.

• Sends acknowledgment to the State/Feds within 24 hours of receipt.

• Forwards BEER/IRS Asset Match/FTB Asset Match abstracts to clerical.

3. Clerical • IDs the case if open in SCCIEVS system.

• Checks the SCCIEVS to see if any of the Requests already exist or have a companion case.

If case is... Then...

Open and assigned in SCCIEVS, to an EE, and period overlaps,

• Enters a new case record in SCCIEVS.

• Forwards abstract to assigned EE.

Open in SCCIEVS and is pend-ing assignment,

• Enters a new case record in SCCIEVS.

• Files abstract in the case and assign to available EE.

Closed or does not exist in SCCIEVS,

• Distributes abstracts equally to EEs for reading (D/ND/DC) with the due date.

• Monitors completion and advises EE Supervisor when appropriate.

• Enters the EE assignment on the BEER/IRS Asset Match/FTB Asset Match Case Roster and in the SCCIEVS application.

REMINDER: BEER/IRS Asset Match/FTB Asset Match abstracts and rosters must be kept in a locked drawer at all times when not being worked on.



4. EE • Receives abstract.

• Reviews cases and determines if D, ND or DC. Determines if earnings/assets are reported and entered in CalWIN.


Active and discrepancy exists, • Complete SCD 1604 so EW can determine if earnings/assets must be recorded in CalWIN for current and future benefit eligibility. [Refer to “Sending IEVS Communication to DO,” page 63-19 for details.]

• Complete "BEER 1st Client Letter" or "FTB/IRS 1st Client Letter,” which can be found in the S: drive, indicating the name and type of unreported earnings or assets, appropriate tax year and 10-day due date. REMINDER: The Client Letter must be sent to the client within 45 days from the Run Date.

• Forwards abstract, Client Letter and SCD 1604 to Assignment Desk to follow next steps.

Inactive and discrepancy exists, • Complete “BEER 1st Client Letter” or “FTB/IRS 1st Client Letter,” which can be found in the S: drive, indicating the name and type of unreported earnings or assets, and appropriate tax year.

• Forwards abstract and Client Letter to Assignment Desk to follow next steps.

ND (No discrepancy exists), • Forwards to Assignment Desk to file abstract in a secured cabinet in a locked room.

DC (Discrepant/Completed), • Forwards to Assignment Desk to file abstract in a secured cabinet in a locked room.

• Updates reading status to Discrepant-Completed in SCCIEVS.

• Notates findings on the abstract.


Step Who Actions



5. Clerical • Receives abstracts and, if applicable, SCD 1604 or Client Letter from EE.

• Enters information (Open/Close) in BEER/IRS Asset Match/FTB Asset Match Case Roster and files it in the locked cabinet in a locked room.


D (Discrepant), • Opens case in SCCIEVS by entering data on the following fields:

• Last Name• First Name• Case Number• Referral Type (FTB, BEER, or IRS)• Open Date• Language• EW #• CalWIN Case Status• IEVS Case Status• Food Stamps• Assigned EE• Assigned Date• Reassigned EE• Reassigned Date• Comments (Indicate Run Date and Wage/Tax

Year)

• Creates IEVS Working folders, which contains abstract, Client Letter and, if applicable, SCD 1604 and forwards to Confidential Verification Desk.

ND (No discrepancy exists), andDC (Discrepant/Completed),

Files abstracts in a secured cabinet in a locked room.


Step Who Actions



6. ClericalEE

Days 1-10

• Receives IEVS working folders from clerical.

• Follows “Sending IEVS Communication to DO,” page 63-19 for cases with SCD 1604.

• Requests employer verification from the Online Work Number.

• Monitors “BEER 1st Client Letter” or “FTB/IRS 1st Client Letter” located in the S Drive.


• Returns "Client Letter" with complete verifications,

• Enters receipt in the SCCIEVS.


• Forwards working folder to clerical for assignment.

• Returns "Client Letter" but (more) verification is needed, or

• Did not return "Client Letter,"

• Generates “BEER 2nd Client Letter” or “FTB/IRS 2nd Client Letter” located in the S Drive.

Days 11-20• Monitors “BEER 2nd Client Letter” or “FTB/IRS 2nd Client Letter” located in the S Drive.


• Returns “2nd Client Letter” with complete verifications,

• Enters receipt in the SCCIEVS.


• Forwards working folder to clerical for assignment.

• Returns "Client Letter" but (more) verification is needed, or

• Did not return "Client Letter,"

Assigns case to EE Lead as a “Confidential Verifi-cation Desk Closing.”


• Assigns IEVS working folders to EE via round robin assignment.

Step Who Actions



7. EE • Receives IEVS case from Assignment Desk.

• Follows Benefit Calculation Process. [See “Benefit Calculation Process,” page 63-6.]

• Once complete, IEVS Supervisor will separate documents to be IDM’d or to be filed in a secured cabinet in a locked room.


8. EE Lead • Reviews cases under “Confidential Verification Desk Closing.”

• Approves/ Denies "Confidential Verification Desk Closing.”

• Completes an SCD 1604 and makes Fraud referral to SIU for Approved "Verification Desk Closing" with Active benefits case. [Refer to “Sending IEVS Communication to DO,” page 63-19 for details.]

• Forwards decision to Confidential Verification Desk for action.

9. Clerical • Receives list of cases approved/denied for “Confidential Verification Desk Closing.”

• Closes cases approved for closing by EE Lead in SCCIEVS and files in a secured cabinet in a locked room.

• Forwards cases denied for closing to clerical for round robin assignment or follow instructions of EE Lead, whichever is applicable.

Step Who Actions



63.5 Intentional Program Violation

This subsection outlines the processes when Intentional Program Violation (IPV) referrals are received from SIU.

Step Who Actions

1. SIU • Sends a hard copy or emails IPV referral to IEVS Verification Desk inbox.

2. Clerical • Receives IPV referral from SIU, prints and date stamps referral.

• Creates working folder.

• Creates case in SCCIEVS and assigns to EE based on language via round robin assignment.



3. EE • Receives IPV case assignment.

• Reviews case in CalWIN and assesses if and additional AE OP calculation applies.

• Notates receipt of IPV referral and review in Maintain Case Comments window under Sanction/Penalty type.

• Reviews the IPV Online Automation System for prior convictions. Add convictions, if any. NOTE: The maximum conviction is three (3). Once a person hits his/her 3rd conviction, he/she is permanently disqualified from the program.

• Reviews VACS if there is an OP balance.

• Reviews IDM for supporting documents.

• If claim is active or open, change OP type to IPV in CalWIN.

• Applies IPV sanction in CalWIN

Note:For CalWORKs cases, sanction must only be applied if the case is active. IPV sanction information can be found on the IEVS applicant report. At which time, District Office EW will apply the IPV sanction for CalWORKs and mail the appropriate Notice of Action.

• If CW case is closed, enter the IPV sanction with end date of 2099 so that individual will not be approved erroneously if reapplies for CW benefits.

• Establishes and computes Administrative OP in CalWIN if OP occurred because of a late application of IPV sanction. Documents actions in the Maintain Case Comments window in CalWIN under Sanction/Penalty type.

• Completes applicable forms and send NOAs.

• Updates status to Transfer to Supervisor in SCCIEVS.

• Submits case documents to Supervisor for review.

REMINDER: IPVs must be processed within 45 days from the date SIU sent the referral IEVS in order to comply with State guidelines.

4. Supervisor • Reviews case.

• If case is correct, submits case for IDM.

• If case is incorrect, returns case to EE for corrections.

5. Clerical • Receives case documents from Supervisor.

• Prepares documents for scanning.

• Scans documents into IDM.

• Returns documents to Supervisor.

Step Who Actions



63.6 General Fraud

This subsection outlines the processes when General Fraud referrals are received from SIU.

Reminder:

General Frauds must be completed within 30 days from the date referral was received from SIU.

6. Supervisor • Forwards copies of all case documents to Recovery and Legal and original documents to SIU.

Step Who Actions

1. SIU • Determines General Fraud and refers to IEVS.

• Hand delivers referral to the Cleribal basket for EE assignment.

2. Assignment Desk

• Date stamps referral documents.

• Enters referral in SCCIEVS with assigned EE.

• Assigns case to EE based on language via round robin assignment.

3. EE • Receives assignment in SCCIEVS and case folder from clerical.

• Determines if additional verifications are needed.

If verification is... Then EE...

Incomplete • Emails the investigator the list of missing verifications, due date and copies the SIU and IEVS Supervisor.

• Updates case status to Pending Verification in SCCIEVS.

REMINDER: If required verification is not received within 30 days, the working folder must be submitted to the EE lead/Supervisor for or follow-up with SIU supervisor.

Complete • Follows Benefit Calculations Process, page 63-7.

• In addition to all required forms and notices, completes the DAOP3.

Step Who Actions



4. IEVS Supervisor

• Reviews completed case.• If case is correct, submits case for IDM and updates status to complete in SCCIEVS.• If case is incorrect, returns case to EE for corrections and updates case status to Return

to EE in SCCIEVS.

If case is... Then Supervisor...

Correct • Submits case for IDM.• Updates Case Status to Complete in

SCCIEVS.

Incorrect • Returns case to EE for corrections.• Updates Case Status to Returned to EE in

SCCIEVS.

5. Clerical • Receives case documents from Supervisor.


• Scans documents into IDM.

• Returns documents to Supervisor.

6. IEVS Supervisor

• Forwards original documents to SIU.

Step Who Actions



63.7 Child Support Default and Trial Referrals

This subsection outlines the processes when requests are received from the Department of Child Support Services (DCSS).

Step Who Action

1. DCSS Faxes Child Support Default/Trial Requests to IEVS

2. Clerical • Receives the Child Support Default and the Trial Requests via email fax and date stamps documents.

• Within 24 hours of receipt, sorts and files the Requests according to Court or the Hearing date and urgency.

• If other calculations are assigned to an EE, assigns to the same EE.

• Checks CalWIN to find all companion cases (DEBS and Foster Care).

• Forwards to Assignment Desk for case assignment

REMINDER: This process must be completed on a daily basis. Requests are time sensitive and must be processed at least five (5) days prior to a Trial or Hearing Date.

3. Eligibility Examiner

• Receives IEVS case from Clerical.

• Within 24 hours of receipt, reviews case to determine priority.

• Contacts DCSS if extension is required.

• Reviews microfiche if the information is not in the CalWIN system.

• Completes the Aid Period Worksheet, affidavit attachment and court letter.

REMINDERS: One affidavit form must be completed for each case. For Foster Care cases, the payee name must be replaced with “Foster Care”.

• Creates packets for DCSS and IDM.

• Sends required documents (i.e., Child Support Affidavit) to DCSS to the fax number on the cover letter.

• Submits case documents to Clerical for IDM scanning.

4. Clerical • Receives case documents from EE.


• Scans documents into IDM and reviews for quality assurance.

• Destroys documents when applicable.



63.8 Compliance Desk Process

This subsection outlines the processes when an IEVS case involves a benefit case that is active in the District Offices (DO).

63.8.1 Sending IEVS Communication to DO

The process below must be followed when it is determined that the “IEVS Communication” (SCD 1604) must be sent to an EW :

Step Who Action

1. EE • Determines that IEVS case is linked to an active/pending benefit case and action must be taken on the client’s benefits.

• IDs the active/pending benefits case in CalWIN and completes the SCD 1604.

• Forwards the completed SCD 1604 to the IEVS Verification Desk inbox.

• Updates the Case Status to Pending SCD 1604 if the case is currently assigned to them as computation assignment.

2. Clerical • Completes and/or snap scans the SCD 1604.

• Creates Urgent TMT request and attaches the SCD 1604 with instructions.

3. District Office • Assigns task to the appropriate EW via TMT.

• EW completes task.

• Documents actions on SCD 1604 and gives to Supervisor for review.

• EWS reviews case actions taken; scans the completed SCD 1604 into the IDM system and sends an e-mail to IEVS Verification Desk inbox within five (5) working days of completion.

4. Clerical • Receives email from EWS.

If the case is... Then...

Unassigned Updates Case Status to Completed in SCCIEVS.

Assigned Forwards to EE for review.

5. EE • Receives SCD 1604s for cases currently under computation assignment.

• Validates computation

• Updates SCCIEVS case status to Completed once all computations are finalized.


63. IEVS Unit Workflows...page 63-2 Common Place 63. IEVS Unit Workflows Page 63-2 Update #18-03•...

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