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Enterprise Program Integrity Control System (EPICS)

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1900 – GLOSSARY

Change #1-2004

July 1, 2004

1ST PAYMENT DUE DATE. The

client’s first payment due date.

A

CASEWORKER ID. A unique number that identifies the caseworker. Also known as the IMC ID number.

   

ACCEPTANCE DATE. The day (MM/DD/YYYY) the investigator accepts the referral.

CASE REASSIGNMENT. The ability to reassign a case from one investigator to another.

   

ADDRESS TYPE. The type of address the client uses (e.g. Physical address). See Appendix A.

CASELOAD REASSIGNMENT. The ability to reassign an entire caseload from one investigator to another.

   

AGENCY ERROR. An overissuance made to a client caused by the County or State.

CHECK NUMBER. The number of the check received from the payor.

   

AGENCY ERROR TYPE. Defines the type of agency error as State, or County.

See Appendix B.

CIVIL JUDGEMENT DATE. Date (MM/DD/YYYY) that indicates when a civil judgement was entered against the debtor.

   

ALIAS NAMES. One or more alternate names for the client.

CLAIM. Established overpayment subject to collection process.

   

ALIAS SOCIAL SECURITY NUMBERS. One or more social security numbers used by the client.

CLAIM TYPE. The type of overpayment claim (Suspected Claim, Agency Error, Intentional Program Violation, etc.). See Appendix B.

   

ALLEGATIONS. A description of the alleged fraud.

CLIENT NAME. Name of the client who is Head of Household or Case Head Payee.

   

ASSIGNMENT DATE. The day (MM/DD/YYYY) the referral was assigned to the investigator.

CLOSED. A “Y” or “N” value used to close a referral.

   

C

COLLECTION. A referral status indicating that payments can be applied to the claim.

   

CASE ID. The Program Case ID

associated with the referral.

COLLECTION FLAG. A “Y” or “N” value indicating whether a claim is currently being collected upon.

COLLECTOR. The caseworker number of the person currently responsible for collecting the funds as a result of an overpayment.

D

   

COMMENTS. The text field used to record comments relating to the claim

DATE CLOSED. Day (MM/DD/YYYY) the referral was closed.

   

CONTACT NAME. The first and last name of the authorized user designated to handle disqualification verifications for the specified county.

DATE OF BIRTH (DOB). The day (MM/DD/YYYY) the person was born.

   

CONTACT TITLE. A text field containing the official job title of the authorized user.

DATE RECEIVED. Day (MM/DD/YYYY) the payment is received.

   

COUNTY CASE NUMBER. The county case number associated with the referral.

DATE SIGNED. (MM/DD/YYYY) the repayment agreement was signed by the debtor.

   

COUNTY CODE. A code used to uniquely identify the county. See Appendix E.

DEBTOR(S). Person(s) financially responsible for the repayment of a claim.

   

COUNTY TRANSFER. The process of transferring ownership of established claims. Claims can be transferred to another county due to the relocation of the person on the referral/claim.

DISQUALIFICATION(S). A penalty(s) invoked for a person convicted of an Intentional Program Violation. The disqualification restricts a person from receiving benefits for a period of time as defined by program policy, depending upon the number of offenses recorded for the person in the past. Applies to WF and FS only.

   

COUNTY WORKER NUMBER. The county worker IMC ID number

DISQUALIFICATION NUMBER. A number that identifies how many offenses an individual has had imposed. Applies to WF and FS only. See Appendix D.

   

CRIMINAL JUDGEMENT DATE. Date (MM/DD/YYYY) that indicates when a criminal judgement was entered against the debtor.

DISQUALIFICATION METHOD. The method by which the disqualification was established. Applies to WF and FS only. See Appendix D.

   

CURRENT BALANCE. The current amount due on the claim.

DISQUALIFICATION PERIOD. A number of months identifying the length of the disqualification. Applies to WF and FS only. See Appendix D.

   
 

DISQUALIFICATION DECISION DATE. Date (MM/DD/YYYY) a decision for the disqualifi-cation was made. Applies to WF and FS only.

DISQUALIFICATION START DATE. Beginning date (MM/DD/YYYY) for the disqualification. Applies to WF and FS only.

I

   

DISQUALIFICATION END DATE. Ending date (MM/DD/YYYY for the disqualification. Applies to WF and FS only.

INDIVIDUAL ID. The client’s ID from which the last activity occurred. Name Search (CNDS).

   

E

INITIAL BALANCE DUE. Total amount of the established overpayment.

   

EFFECTIVE DATE OF TRANSFER/ Date (MM/DD/YYYY) the referral is to be effectively assigned to the new investigator or county.

INADVERTENT HOUSEHOLD ERROR. A claim type used by all Programs. Known to Medicaid as a Client Error.

   

EIS/FSIS ADDRESS. The client’s

address that is posted in EIS/FSIS.

INTENTIONAL PROGRAM VIOLATION. A claim type used by all Programs. Known to Medicaid as Fraud.

   

END DATE. The end date (MM/DD/YYYY) of the assignment to the county.

INVESTIGATION. Process to determine the validity of the allegations.

   

EPICS ADDRESS. An address that Program Integrity uses that is different from the address in EIS/FSIS.

INVESTIGATOR ID. The ID of the investigator currently assigned to the case.

   

ESTABLISHMENT DATE. Date (MM/DD/YYYY) the claim was originally established

L

   

F

LAST ACTIVITY. The activity code that was last performed on the disqualification.

   

FAX NUMBER. The client’s fax number.

LAST ACTIVITY DATE. Date on which the last activity occurred.

   

FIRST NAME. The client’s or debtor’s first name from Name Search (CNDS).

LAST NAME. The client or debtor’s last name from Name Search (CNDS).

   

FREQUENCY. Defines how often the client is expected to make payments. See Appendix B.

M

   

FRONT-END REFERRAL. Code used for the type of referral that resulted from an application with questionable information.

METHOD OF COLLECTION. The means by which the overpayment is collected. See Appendix C.

MIDDLE INITIAL. The client’s or debtor’s middle initial of the full name.

OVERPAYMENT/OVERISSUANCE PERIOD. Actual beginning and ending date of the overpayment overissuance.

   

N

OVERPAYMENT/OVERISSUANCE BALANCE. Current balance of the claim.

   

NAME. The Last Name, First Name, Middle Initial of the client or debtor.

P

   

NATURE OF REFERRAL. Code used to designate the nature of suspected. See Appendix A.

PAYMENT AMOUNT. The debtor’s monthly payment.

   

NEW INVESTGIATOR. The investigator ID and full name of the new investigator being assigned to the specified cases.

PAYMENT METHOD. Method the debtor is expected to use to make payment. See Appendix B.

   

NUMBER OF PAYMENTS. The total number of payments required by the debtor to pay off the balance of the claim.

PAYOR NAME. The Last Name, First Name, and Middle Initial of the person making the payment.

   

O

PENDING. One of the codes used for Referral Status.

   

OPEN DATE. Date (MM/DD/YYYY) The investigator opened the case.

PHONE NUMBER. The client’s or debtor’s phone number.

   

ORIGINATING COUNTY. The ID for the county in which the suspected overpayment took place.

PHONE TYPE. The type of phone number the client uses (e.g. home). See Appendix A.

   

OTHER REFERRAL. A code used for Type of Referral.

PROGRAM CODE. The benefit program associated with the referral. See Appendix A.

   

OVERPAYMENT AMOUNT. The established amount due from the claim.

PROJECT RECALL REFERRAL. A code used for the Type of Referral.

   

OVERPAYMENT BEGIN DATE. Start date of the overpayment.

R

   

OVERPAYMENT END DATE. End date of the overpayment.

RACE. The race of the client or debtor. See Appendix B.

   

OVERPAYMENT PERIOD. Actual beginning and ending date of the overpayment.

REASON CLOSED. The text field used to describe the reason the referral was closed.

RECEIPT NUMBER. The payment receipt number.

REGULAR REFERRAL. A code used for Type of Referral.

   

REFERRAL. The origination point for a claim in EPICS.

REPAYMENT AGREEMENT. A formal document signed by the debtor, indicating the method in which the overpayment amount will be repaid.

   

REFERRAL DATE. The date (MM/DD/YYYY) the referral was initiated.

S

   

REFERRAL DETAIL. Screen used to display, update, or add referrals to the EPICS system.

SERVICE CODE. Code identifying the type of Medicaid Services provided during the overpayment period. See Appendix B.

   

REFERRAL ID. A system generated ID number that is assigned to a referral/claim throughout the EPICS process.

SEX. Code indicating the sex of the client or debtor. See Appendix B.

   

REFERRAL LIST. A list of referrals assigned to a specific investigator within a specific county, or unassigned within a specific county.

SOCIAL SECURITY NUMBER. The client’s or debtor’s social security number.

   

REFERRAL SOURCE. The two-digit code that represents the source of the violation. See Appendix A.

START DATE. Effective date (MM/DD/YYYY) a new user is assigned to an authorized user detail group.

   

REFERRAL STATUS. Defines the current status of the referral. See Appendix A.

SUBSTANTIATION METHOD. Method by which the allegation was substantiated as IPV. See Appendix B.

   

REFERRAL TYPE. Defines the type of referral a client has (Regular, Project Recall, Front-End, Other). See Appendix A.

SUSPECTED AMOUNT. The suspected amount of money involved in the alleged overpayment/overissuance.

   

REFERRING PERSON. Name of the person providing the investigator with the referral. NOTE: This person can be anonymous.

SUSPECTED OVERPAYMENT/ OVERISSUANCE PERIOD. The suspected beginning and ending date of the alleged overpayment/overissuance.

   

REFERRING PERSON PHONE. The referring person’s phone number.

 
   

REGION. Code used to identify the region within the state where the county is located.

 

T

 
   

TAX INTERCEPT COORDINATOR. The individual designated to coordinate tax intercept activities for a specified county.

 
   
   

TERMINATED. A claim that has been terminated.

 
   

TITLE. The title of the Notepad entry.

 
   

TRANSFERRED. The action taken to move a client’s EPICS case from one county to another.

 
   

TRANSFER DATE. The date (MM/DD/YYYY) the claim was transferred from one county to another.

 
   

TYPE OF CLAIM. Identifies the type of overpayment claim. See Appendix

 
   

U

 
   

UNASSIGNED. One of the codes used for Referral Status.

 
   

USER ID. The RACF ID used to log into the Mainframe.

 

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