Medicaid CAR Guide Instructions: Revenue Maximization Unit Supervisory Review

  1. Application/review form/change form

    • For applications, is a signed application in the CR? For reviews, is the review document in the CR? For changes, is the change form in the CR?

    • Documented for all case actions and indicate type of contact and/or action taken?

  2. Correct forms in case record?

    • All appropriate forms in case record?

    • Is the case record organized per established standards?

  3. Address correct?

    • Is the placement name and address correct in Residential Address?

    • Is the custody county name and address correct in Mailing Address?

  4. Adoptive placement/relative care established and documented?

    • Are adoptive parents documented as AREP?

    • For a new relative care placement for a child in DFCS custody, is the relative name, address and relationship entered as AREP? Documented?

  5. Denial/closure completed timely, accurately and documented?

    • If case was denied, was correct denial reason used, and was denial reason thoroughly documented in Remarks?

    • If case was closed/CMD, was correct closure reason entered? Closure reasons thoroughly documented in Remarks?

  6. Timely and correct notice for action taken?

    • Is a notice sent to the SSCM, by the SOP of the application, review, change explaining the AU’s eligibility?

  7. Retroactive Medicaid documented and correctly coded?

    • Retroactive months correctly determined, documented and processed?

  8. Period of eligibility addressed and documented?

    • Correct month of eligibility?

    • Historical changes

    • Denial of removal month explained

  9. CMD completed?

    • Was a CMD completed, if appropriate? Circumstances and outcome of CMD?

  10. Alerts addressed?

    • Have all alerts been completed and documented?

  11. Deprivation established, coded and documented?

    • Was deprivation correctly determined and documented?

  12. Pregnancy verified and documented?

    • Pregnancy verified? Was correct date of termination entered?

  13. Citizenship and identity documented and verified?

    • Citizenship addressed? Any verification provided? Is copy in record?

    • If alien, WEB-1 VIS/CPS verified and documented as to DHS status and date of entry? Alien status documented?

  14. TPR/Immunization and Health Check addressed and documented?

    • Were TPR and Health Check addressed and documented?

  15. Screens coded and documented?

    • Is SSN entered and if there is no SSN or a matching problem, is there documentation to resolve discrepancy in record?

    • Are DOB, sex, race, marital status and living arrangement coded correctly?

    • Is SSI documented correctly for AU member who receives SSI benefits?

  16. EMA verified and documented?

    • Are EMA dates of service keyed correctly?

    • Is correct, signed form 526 in record?

  17. School information documented, if known?

  18. Each case action documented in detail with date, type of action, Rev Max Specialist’s last name, first initial and regional unit identified and phone number?

    • Prior month’s MAO addressed, and action taken

  19. Clearinghouse checked and all discrepancies in information researched and documented?

  20. SDX/BENDEX/UCB discrepancies addressed and documented?

    • Are the SDX, BENDEX, and UCB screen results documented and addressed?

    • Unearned income entered for RSM COA?

    • If member receives SSI or RSDI, is SDX/BENDEX result documented and verified with the SSCM’s statement to verify income?

  21. Verification obtained and documented?

    • Is the type of income received verified and documented?

    • Child support coded correctly? CS/CD/GP

      • If child support is received through OCSS, is the income coded as (CS) on the child’s line number who receives the income?

      • If the county receives direct child support from an absent parent, is the income coded as (CD) and on the child’s line number who receives the income?

  22. Document OSOP reason?