P1102 How to Disenroll A Customer During a Guaranteed Enrollment  Period (Continuous Eligibility Period or CE)

Step

Action

1

When a customer is inappropriately enrolled during a guarantee period, staff should submit a Policy Clarification Request (PCR) to request the customer be disenrolled. The PCR should include the following information in the PCR description field: 

• Customer name

• Application ID

• Specific reason for inappropriate approval

2

Add a PCR using “CE Inapprop Approval” as the short title.

3

When the PCR response is received, add a case note in HEAplus of the outcome. Include the following information:

• PCR number

• What happened that caused the application to be inappropriately approved

NOTE     AHCCCS staff should add the PCR response into EDMS.

Step

Action

1

When a customer is inappropriately enrolled during a guarantee period, FAA staff should Raise an andon when a participant needs to be disenrolled during a CE period due to inappropriate approval (approved in error). 

2

The supervisor or office manager will respond to the Benefit Eligibility Specialist’s (BES) andon and complete a review of the application to determine whether the disenrollment action is valid.

3

When the supervisor or manager determines the disenrollment is valid, the application should be elevated to the AHCCCS Office of Eligibility Policy (OEP) for disenrollment.  The BES’s supervisor or manager sends an email to DMS-PolicyClarificationRequest@azahcccs.gov and includes the following information:

1. Email Subject: PCR - CE Inapprop Approval

2. Customer name

3. Application ID number

4. The specific reason for inappropriate approval

4

OEP will:

• Respond to the FAA supervisor or manager via email to confirm the disposition to stop benefits was completed and a decision letter was sent.  

• Include the AHCCCS Policy Clarification Request (PCR) number in the email.  

• Add a case note to HEAplus by OEP to document the disenrollment action.