Periodic Post-Eligibility Verification Overview

 

Currently, RI UHIP verifies customer self-attested information against Federal and State external data sources during initial submission or resubmission of an application. Verification of customer self-attested information validates what customers enter or update on their application and is used by the system to determine eligibility.

Post Eligibility Verification increases the frequency of data verification for certain data points and provides additional admin override functionality. This enhancement is intended to ensure information self-attested by customers is verified on an automatic and continuous basis after the initial eligibility determination. Data to be re-verified during post eligibility verification includes: Incarceration, Death Data, Wages and Unemployment Benefit income. Additionally, admin override functionality has been changed to align with post eligibility verification.

Under what conditions is the Periodic Post Eligibility Verification process run:

·         Periodic Post-Eligibility Verification is performed for existing customers who are:

o    Medicaid eligible with verified citizenship/immigration status

o    QHP/APTC/CSR eligible with an active enrollment status

 

When is  Periodic Post Eligibility Verification not performed:

·         Periodic Post-Eligibility Verification is not performed for existing customers:

o    Where a verification task on an existing account has been closed within the last 30 days

o    Where an application has been submitted or resubmitted within the last 30 days

o    Within 2 months of the renewal date for Medicaid/Mixed household

o    Within 1 month the open enrollment period for QHP

o    When Medicaid Pending

o    Pending for Medicaid eligibility with unverified citizenship/immigration status

o    Conditionally for  QHP/APTC/CSR

 

Process Steps

Step 1: System runs post-eligibility verification

1.     Using State verification sources, RI UHIP performs a verification check as indicated in the table below

Data Point

Data Source

For

Schedule

Incarceration

Department of Correction (DOC)

QHP and  Medicaid

Last Friday of Each Month

Death Data

Department of Health (DOH) – Death Data

QHP and  Medicaid

Last Friday of Each Month

Current Income – Unemployment

Department of Labor and Training (DLT) – UI

Medicaid

Last Friday of Each Month

Current Income – Wages

Department of Labor and Training (DLT) – SWICA

Medicaid

Last Friday in February, May, August and November

 

2.     If all data points are verified, no additional action is required by the customer and benefits continue.

3.     If unverified information is found:

a.     The customer is informed via an email alert to log back into the system to verify information.

b.    An R-Doc is sent to the customer.

c.     A PEV – Unverified Information (QHP) or PEV – Unverified information (Medicaid) task is created for the admin dashboard.

Step 2: If Customer provides the Verification in a timely manner:

1.     An admin user uses the  PEV – Unverified Information (QHP) or PEV – Unverified information (Medicaid) to override the system verification and upload supporting documents

MC910220951[1]

Use the Act on Tasks – Unverified Information PEV to get more information on how to verify information and upload documents for PEV Tasks.

 

 

2.     System re-determines eligibility with new data.

3.     A notice is sent to customer notifying them of the eligibility outcome.

4.     The PEV task is automatically closed.

Step 3 – If the Customer does not provide the Verification in a timely manner

1.     System re-runs eligibility using from data external data sources.

2.     A notice is sent to the customer notifying them of the eligibility outcome.

3.     The PEV – Unverified Information (QHP) or PEV – Unverified information (Medicaid) task is automatically closed.