MA1301B

Was the application processed in HEAplus by 3:30 pm?

• If YES, check the customer in WAVES the first business day after the application was processed.

• If NO, check the customer in WAVES the second business day after the application was processed.

Is there a demographic error that may be preventing the customer from getting benefits?

• If YES, correct the demographic error. Continue to Step 3.

• If NO, continue to Step 4.

Is proof needed to determine eligibility for the customer?

• If YES, tell them what is needed and help get proof (MAP1301B). Continue to Step 4.

• If NO, process the application for the customer, then:

• When the customer is eligible, skip to Step 5.

• When the customer is not eligible, STOP.

Did you get all the proof needed to determine eligibility for the customer?

• If YES, process the application for the customer.

• When the customer is eligible, continue to step 6.

• When the customer is not eligible, STOP.

• If NO, STOP. Deny or discontinue the customer when the due date or requested extension date passes.

Ask the customer if they require an immediate hospital admission due to a medical condition or an immediate admission to a behavioral health treatment center.

• If YES, continue to Step 7.

• If NO, STOP. The customer’s eligibility does not need priority posting.

Does the customer need medical services within five days from now?

• If YES, continue to Step 8.

• If NO, STOP. The customer’s eligibility does not need priority posting.

Create a referral to expedite the system record in PMMIS.

• DES see section 2

• AHCCCS see section 3

Has the decision letter for the customer’s eligibility been sent?

• If YES, skip to Step 3.

• If NO, continue to Step 2.

NOTE     In HEAplus, review the notification history. When there is a bulk reference number for the customer’s letter, then it has been sent.

Is the letter correct?

• If YES, enter case notes that the letter has been checked and is correct.

• If NO:

  • Correct the letter if able and enter case notes that the letter is correct; or

  • Explain in case notes what is incorrect, why the letter cannot be corrected, and how the customer will get a correct letter.

NOTE     If the letter has not been sent and there are no case notes about the letter, the referral will not be processed.

Open OnBase Unity from the icon on your desktop.

NOTE     If you do not have an OnBase Unity icon, notify your supervisor.

Select forms at the top of the icon menu.

Select the FAA-Medical Emergency Request e-form from the column on the left.

Complete the customer’s name, DOB, SSN and details about the request on the form. If the letter has not been sent, note that the letter has been confirmed to be correct.

Are there more than 7 customers that require an immediate hospital admission due to a medical condition or an immediate admission to a behavioral health treatment center?

• If YES, complete more than one form to include all customers with the same request. Continue to Step 8.

• If NO, enter the information for each customer on the form. Continue to Step 8.

Enter the customer’s name and telephone number under the “AHCCCS will contact?” section on the bottom left side of the Person # tab on the e-form. If you leave it blank, the customer will not be notified by AHCCCS when the priority posting occurs. Continue to Step 9.

NOTE     It may take up to 4 business days for the priority posting to be completed.

Click on the SUBMIT button when all the information is entered for each customer.

NOTE     You will receive an email telling you the form was submitted successfully.

Log in to HEAplus and go to the notification history section. Does a batch reference number display for the decision letter?

• If YES, continue to Step 2.

• If NO, check to make sure the decision letter and eligibility are correct. Make any changes needed. Enter case notes stating that the eligibility and the letter are correct and how the customer will receive their letter. Continue to Step 2.

Check the RP145 screen in PMMIS to see if the eligibility has already posted with the correct information. Has the eligibility posted correctly?

• If YES, STOP. Check the demographics and make sure they are correct. No further action is needed.

• If NO, continue to Step 3.

Check to see if a referral was already created by entering CM605 in the NTR field and the customer’s AHCCCS ID in the AHCCCS ID field.

NOTE     If you do not have an AHCCCS ID enter the customer’s last name in the RCP NAME field.

Is there a referral with status code “A”, “S”, “V” or “W”, with the same code reason in the PROB field?

• If YES, STOP. No further action is needed.

• If NO, continue to Step 4.

Go to the Case Management (01) screen in PMMIS.

Enter CM610A to create a referral.

Enter MF in the DEST field to send the referral to OCARE.

Place your cursor in the PROB field and press the F1 key. Select the code that identifies the needed update in PMMIS.

NOTE     When the customer has a pending hospital admission and does not currently have Medical Assistance coverage, select the EL code for “Eligibility” by placing “S” in the SEL field next to the code.

Place your cursor in the ELIG field and press the F1 key. Select AC for AHCCCS Care by placing “S” in the SEL field next to the code.

In the PRIOR field enter Level I for a pending hospital admission and does not currently have Medical Assistance coverage and level II for referrals that are not an emergency. Enter your name in the Caller field.

Enter Y in the “RETURN CALL?” field.

Enter the customer’s name and phone number.

NOTE     If you do not enter the return call information, the customer will not be called when the eligibility posts.

Enter the customer’s information which must include the AHCCCS ID or the customer’s SSN and DOB.

Press Enter to submit the referral.

NOTE     You will get an error message if it is unsuccessful.