DSS ADMINISTRATIVE LETTER FOOD ASSISTANCE and ENERGY
FAMILY SUPPORT & CHILD WELFARE SERVICES Administrative Letter No. 07-03
DATE: DECEMBER 19, 2003
SUBJECT: NEW PROCEDURES FOR CHANGES TO CLAIM AMOUNTS AND BALANCES IN EPICS
DISTRIBUTION: COUNTY DIRECTORS OF SOCIAL SERVICES
INCOME MAINTENANCE SUPERVISORS
INCOME MAINTENANCE CASEWORKERS
PROGRAM INTEGRITY SUPERVISORS
PROGRAM INTEGRITY INVESTIGATORS
The purpose of this letter is to explain the new procedures for revising claims in EPICS in the following situations: (1) when the overpayment amount must be changed in EPICS, (2) when a current balance must be adjusted, and (3) when a claim must be closed in EPICS. The new process will improve the efficiency of the system and the integrity of the data in EPICS.
The overpayment amount must be corrected in EPICS when an error is discovered in the calculation or keying of the overpayment amount. Prior to this change, EPICS required two transactions in order to change the overpayment amount: (1) entry of the correct amount in the Overpayment Amount field on the Claim Detail screen, and (2) entry of an AJCD or AJCI transaction on the Payment screen for the amount of the decrease or increase.
The new procedure will automatically synchronize the Overpayment Amount and Current Balance fields on the Claim Detail screen. The procedure is as follows:
Example: On 10/01/ 2003, a claim was showing an overpayment amount of $300.00 and a current balance of $75.00. Through supervisory review, it was discovered that the correct amount of the overpayment/overissuance is $400.00. This is an increase of $100.00. Worker enters $400.00 in the Overpayment Amount field of the Claim Detail screen. EPICS will increase the current balance to $175.00 and create an entry on the Payment History screens of $100.00 with payment type of “AJCI.”
Example: On 10/01/2003, a claim was showing an overpayment amount of $500.00 and a current balance of $400.00. Through supervisory review, it was discovered that the correct amount of the overpayment/overissuance is $300.00. This is a decrease of $200.00. Worker enters $300.00 in the Overpayment Amount field of the Claim Detail screen. EPICS will decrease the current balance to $200.00 and create an entry on the Payment History screens of $200.00 with payment type of “AJCD.”
Note: EPICS will not allow payment corrections for AFDC claims outside of the current month.
Example: On 10/01/2003, a claim was showing an overpayment amount of $400.00 and a current balance of $200.00. A cash payment of $200.00 had been posted in EPICS in 09/2003. The correct amount of the overpayment/overissuance is actually $150.00. This is a decrease of $250.00. Since the decrease to the overpayment amount is more than the difference between the existing overpayment amount and the existing current balance, when the F9 key is pressed, the error message appears, “OVERPAYMT AMT LESS THAN COLLECTIONS. PAYMT CORRECTIONS MAY BE NECESSARY.”
Reverse out the entire $200.00 payment by completing a payment correction. Then key the correct amount of $150.00 in the Overpayment Amount field on the CLAIM DETAIL screen. This will correct the Current Balance to $150.00. Then re-key the payment of $200.00 that was reversed out. This will result in the claim being paid in full. Since the claim was over-collected, a refund of $50.00 must be issued to the debtor.
In certain situations, adjustments may be necessary to reduce or increase the balance of claims without changing overpayment amounts. Only State staff will have authorization to make adjustments to claim balances in such situations. If a
county worker tries to use the AJCI or AJCD feature on the Payment Screen, the following error message will appear: “Insufficient Authorization - Restricted to State PI staff only. Contact State PI.”
When such adjustments are necessary, fax a request on county letterhead to the appropriate State DMA or DSS staff. For Medicaid claims, fax requests to Brenda Porter or Shara Britt at 919-715-7706. For Food Stamp claims, fax requests to FAEP Program Integrity Staff at 919-733-0645. For AFDC or Work First claims, fax requests to the Family Support and Child Welfare Services section at 919-715-6714.
The faxed request must include the following information: casehead name, Referral ID, individual ID number of debtor, reason adjustment is necessary, correct balance amount, and signature of supervisor.
On the night of December 31, 2003, EPICS will populate the current balance with the dollar amount in the OVERPAYMENT field for all existing active claims in EPICS with a zero balance on that date. Please review each of the claims listed on the FRD903 ZERO BAL ‘CO’ CLAIMS report dated December 29, 2003 in NCXPTR to determine if a correction is needed to any of the balances, or if the claim must be referred to State DMA or DSS staff for closure.
If you have any questions, please contact the appropriate Program Representative
Gary Fuquay, Acting Director
Division of Medical Assistance
Pheon Beal, Director
Division of Social Services
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.