Affordable Care Act (ACA) - Technological Enhancements Expansion - Automated Case Actions, Real Time Eligibility, and Enhanced Medical Assistance Renewals- Revised 8/31/17, OPS170803 (Published August 15, 2017)
The following automated sources of proof or information are available:
Social Security Number Posting System.
This system provides a listing of the newly issued Social Security numbers that have been posted to the CIS/eCIS database.
IEVS can be used to obtain information about unemployment compensation, SSI benefits, and Social Security benefits. It may also have information on earned income, private pensions and unearned income reported to the Internal Revenue Service.
Asset Verification System (AVS)
AVS is used only to request resource information for aged and disabled applicants or recipients of MA benefits, including Long Term Care (LTC) and Home and Community-Based Services (HCBS). It will not be used to obtain information for those applying for or receiving only MAGI-related MA, Supplemental Nutrition Assistance Program (SNAP), Low-Income Home Energy Assistance Program (LIHEAP), Family Planning, or Family Works.
Federal Data Services Hub (FDSH)
FDSH is a federally maintained service, which provides connection to electronic data sources needed to verify information reported by the individual. FDSH provides the following real-time verification services:
Social Security Administration (SSA) Composite provides verification of the Social Security Number (SSN), U.S. Citizenship, Title II income (RSDI and Railroad Retirement benefits), and incarceration status through the SSA.
Verify Lawful Presence (VLP) is used to verify lawful presence of non-U.S. citizens through the Department of Homeland Security, VLP service is initiated once the Alien/Refugee screen is completed. If VLP is unable to verify immigration information a green alert message will appear. The CAO must follow current SAVE procedure if VLP verification fails. See Supplemental Handbook, Chapter 740, SAVE Procedures.
Remote Identity Proofing (RIDP) is used to ensure the privacy of personal information of individuals who apply and are determined eligible for a multitude of DHS programs, including MA, through the Commonwealth of Pennsylvania Access to Social Services (COMPASS).
TALX-FDSH provides real-time verification of wages used for online eligibility processing, automated renewal processing and eCIS processing for MA-only cases.
TALX-Equifax provides real-time verification of wages used for combination cases (MA,SNAP, TANF, and LIHEAP).
State on-line Query Internet (SOLQ-I) provides real-time verification of Title II and Title XVI (Social Security Income) benefits, SSN, U.S. citizenship directly through SSA.
Commonwealth Judicial Inquiry System (CJIS).
This system provides criminal histories from the Administrative Offices of Pennsylvania Courts (AOPC), Department of Corrections State Prisons (DOCS), the Department of Corrections County Prisons (DOCC), the First Judicial District of Philadelphia Municipal Courts (FJDM), and the First Judicial District of Philadelphia Common Pleas Court (FJDC).
As a part of CJIS, Pennsylvania Justice Network (JNET) provides real-time information from the following sources:
Pennsylvania Board of Probation and Parole (PBPP)
DOCS and DOCC
AOPC
MCI interface with SSA to verify citizenship and identity from SSA’s records.
This process is used to verify citizenship and identity for individuals who declare to be United States (U.S.) citizens if verification through the SSA Composite fails.
The CAO will use automated sources of information for verification before requesting documentation from the individual. The individual’s consent is not needed. The Department of Human Services' (DHS) applications state that an individual’s Social Security number may be used in an automated match. However, the CAO will:
Give the individual the chance to provide other proof if he or she disagrees with the automated information.
Not delay an eligibility determination if automated sources are not available.
Manual Requests for Asset Verification through the Asset Verification System (AVS), OPS180103 (Published January 30, 2018)
Complete information and instructions for use of IEVS are found in "Using IEVS."
IEVS data may only be used to get information about applicants, recipients, and other individuals (such as legally responsible relatives) whose income and resources are used to determine MA eligibility.
The CAO will allow access to IEVS only to staff members who help provide benefits. Information from IEVS must be protected. Improper or unapproved use of IEVS to get information about people other than applicants, recipients or those whose income and resources must be considered, may result in fines, imprisonment or both.
IEVS uses an individual’s Social Security number to get income and/or resource information from the following sources:
Exchange 1
The Department of Labor and Industry (DLI) and the Office of Employment Security (OES) Wage file.
TALX (FDSH and Equifax).
Exchange 2
Department of Labor and Industry (DLI) Unemployment Compensation file.
Exchange 3
The Social Security Administration (SSA) BENDEX Master Benefit Record (MBR) and SOLQ-I.
Exchange 4
BENDEX Earnings Reference File (ERF)
Exchange 5
The Internal Revenue Service (IRS) Unearned Income File.
Exchange 9
Veteran's assistance through the Public Assistance Reporting Information System (PARIS).
Exchange 11
Lottery through the Pennsylvania Department of Revenue.
NOTE: IEVS also uses an individual’s name, date of birth or Social Security Number (SSN) to get criminal history from the CJIS. (Exchange 10)
Exchange 12
Resource information through the Asset Verification System (AVS)
Data exchanges are conducted:
At regularly scheduled times by the automated system for each source. An individual is included in the match if their SSN appears in an active budget at the time of the exchange.
NOTE: The SSN of an individual living in the household but not a member of the applicant/recipient group is also included if that individual is listed in the CIS/e-CIS database.
At renewal, Exchange requests are automatically made for Exchanges 1, 2, 3, 6, and 12.
The CAO can begin a match by completing an online “Exchange Request” transaction through the Exchanges.
When screening applicants for information.
When adding a new member to the applicant/recipient group
At renewal, if the CAO believes that more recent information may be available.
For information about an individual whose income and resources are counted but whose SSN is not included in an active budget.
When the CAO believes that the applicant/recipient group’s income or resources have changed.
Examples:
The CAO believes there has been a change in a recipient’s unemployment compensation that took place after the most recent scheduled unemployment compensation data exchange.
The CAO verifies that an adult recipient is using a minor’s Social Security number for employment purposes.
Responses for some of the sources such as TALX-FDSH, TALX-Equifax, Exchange 3, Exchange 6, and Exchange 10 can be received in real-time. If a real-time response is not received, the CAO should allow 24-48 hours for information to be returned.
Data exchanges requests can be conducted in eCIS Case Processing (CP).
The CAO can manually initiate an IEVS request for TALX in Maintenance Mode from the "Employment and Wages" screen.
Automatic TALX requests are initialed from the Individual Demographics screen in Case Open, individual Add, Program Add, Reapplication, and Partial Reapplication modes.
For MAGI and non-MAGI MA cases automatic real-time data exchange requests are generated for COMPASS online eligibility determinations and Enhanced MA renewals.
When an individual reports a change in Unemployment Compensation, RSDI or SSI on COMPASS, a data exchange request is made.
Information from data exchanges will be reviewed at the time of application, renewal, semi-annual review (SAR ), and when there is a change that affects eligibility. The CAO will act on new or changed information that is identified by the system within forty-five calendar days of the posting of the information to IEVS.
Exception: Although the system provides 45 calendar days, the CAO will act on SSI dispositions within ten days of the posting of the information on Exchange 6 (SDX).
Many MA-only cases do not post a “Hit Pending” when information is received, but the hit is system cleared and shows as “System Evaluated” or it can show a status of “Data Received”. TALX does not post a hit at all, even one that is system cleared. To prevent errors, the CAO must review all exchange information with all Exchange Statuses, TALX information, and take the proper actions needed to update financial and non-financial information on the case record to review and determine eligibility.
Information from TALX, Exchange 1 DLI-Wage, Exchange 2-UC, Exchange 3 BENDEX-MBR, Exchange 6-SSI, and Exchange 10 DOCS-JNET is considered verified upon receipt and may be used without other proof if it is reasonably compatible with information reported by the individual. (See Chapter 378, Section 378.12 Reasonable Compatibility.)
Information from Exchanges 4, 5, 9, and 11 always requires proof. Exchange 8 information is considered verified upon receipt for MA-only cases that go through Exchange 8 automation. If an Exchange 8 hit exceptions to the CAO, additional verification is needed prior to taking action. Exchange 10 information requires proof when the source is not DOCS-JNET. See IEVS/SAVE/PACSES and SAR desk guide for additional information.
NOTE: The Department of Labor and Industry (DLI) has developed an Exhaustion of Unemployment Compensation letter (UC-50) that an individual will supply to the County Assistance Office (CAO) when the CAO needs to verify an individual has exhausted unemployment compensation and the information is not clearly available on Data Exchange 2. The letter confirms the last week payable, not the date the final benefit was issued. Only the individual may request the UC-50 form from DLI.
If information from IEVS was not reported or does not match information given by the individual and the CAO initiates an overpayment investigation by disposing of the exchange hit with an "O", the CAO will:
1. Send a Client Verification Request Form (PA 162-VR) allowing the recipient ten calendar days to respond.
2. Send an Advance Notice to close the budget if the recipient refuses or fails to cooperate or does not respond within 10 calendar days.
3. Ask for proof of income and resources from third parties to find out whether there is an overpayment.
4. Take action based on information found through IEVS, including sending an Advance Notice to close MA, if that is needed.
The CAO will dispose of an IEVS hit within 45 days.
Exception: Although the system provides 45 calendar days, the CAO will act on SSI dispositions within ten days of the posting of the information on Exchange 6 (SDX).
NOTE: Exchange 7 hits are due within 10 days. Exchanges 9a and 10 are due within 90 days. Exchange 9b is due within 60 days.
NOTE: All information received for an individual who is entered as an applicant (Type A) results in a disposition.
A disposition is required for the following situations:
Exchange 1, Wage Information.
The income codes 001–009 do not appear in eCIS.
The employer number is new or different from earlier IEVS information.
Exchange 2, Unemployment Benefit (UC) Information.
The first character of First Name/First three characters of Last Name matches and the UC adjustment code of 010 does not appear in eCIS.
The UC information is new, a UC check was issued within the last 90 days, and the UC income code does not appear in eCIS.
Exchange 3, Master Benefit Record (MBR) Information.
The category is A, J, or M and the activity status in eCIS is different than the status on BENDEX; for example, the status is active in eCIS, but inactive on BENDEX.
Active RSDI, SSI, Black Lung, or Railroad Retirement benefits appear on BENDEX, but income is not adjusted in eCIS.
The amount of RSDI, SSI, Black Lung, or Railroad Retirement benefits is different from earlier IEVS information.
Information shows that the individual went from nonpayment status to payment status.
Information shows a non-PA address.
A new Disability Start Date is reported.
A Medicare Part A/B Start and/or End Date is reported.
Exchange 4, Earnings Reference File (ERF).
Benefits were received during the tax year covered by ERF data and the income varied more than $50 from the previous tax year.
Benefits were received during the tax year covered by ERF data and there was a change in employer from the previous tax year.
There is no earned income budget adjustment for the same tax year.
There is self-employment in the ERF data, but no self-employment was adjusted for the same tax year.
Exchange 5, Unearned Income.
The match shows that income was received from the following document types:
|
|
67 – Stocks |
Interest income for the following categories was more than the amounts shown:
TA, TAN, TAW, TB, TC, TJ, TJW, TU, TJN, TD, TVN, PJN, PJW, PM, PMN, PMW, PJ, PA, PAN, PH, PAW, PVN, PG, PC, MG, PD |
$ 49.00 |
PI, PW |
$150.00 |
Exchange 6, SDX Information.
Newly Authorized SSI Cases.
A disposition reason code appears in the upper right corner of the Details screen for Exchange #6. This code will indicate why the disposition has been set.
01 |
Non-payment of SSI Benefits to a Disabled Adult Child (DAC). |
02 |
Active on SDX, not found or active in the appropriate SSI category in eCIS. |
03 |
eCIS opened in incorrect category |
04 |
Active in eCIS in federal SSI category. Not found active on SDX. |
05 |
Inter-state Move. Individual moved to another state. NOTE: System will automatically process another request to obtain the out-of-state address. |
06 |
Payment amount change and change other than address. |
07 |
Termination/Non-Payment |
08 |
Intra-state move. Individual has moved to another address within Pennsylvania and/or the payment name has changed. |
09 |
Intra-state move. Individual has moved to another address within Pennsylvania and/or the payment name has changed and there is a change in the payment amount. |
10 |
Record was sent for auto SSI opening and failed Master Client Index (MCI) file clearance. |
11 |
Unable to Assign Budget Category Code for Auto-SSI opening because Recipient Type Code is Essential Person or Ineligible Spouse |
Exchange 7, Buy In.
A match shows that there are differences in demographic information between CIS/eCIS and Buy-In or data in one database suggests that the situation in one or more of the other databases may be wrong. A discrepancy code is set.
Exchange 8, Deceased individuals Match.
A match shows different information in the databases. Status Codes 02 and 03 are the only records targeted for worker review and action, although Status Code 02 is automated by the system whenever possible.
Exchange 9a, PARIS Interstate Match and #9b, Veteran's Assistance.
A worker disposition is created when all data elements match for individuals who are currently active in eCIS and appear on the eligibility file of the matching state.
Exchange 10, CJIS.
CJIS exchange sources send the department criminal background information on individuals who meet the Act 20, Act 35, and PRWORA criteria. A match is created from the information received from the exchange sources. The information is not always confirmed by the source at the time of collection. The accuracy of some CJIS exchange source information is uncertain. Because of this situation, CJIS information passes through an extensive matching process with the eCIS database to find all possible matches of a CJIS individual with eCIS. Even after this matching process, the CAO worker must determine whether the match is really the eCIS applicant or recipient.
The information received on IEVS Exchange 10 from DOCS-JNET is considered verified upon receipt. This information may be used to verify when an individual is placed into or released from a correctional facility.
Exchange 11, Lottery
A match with the Pennsylvania Department of Revenue provides information of individuals who claim their lottery winnings through the Pennsylvania Treasury.
Exchange 12, Assets
AVS responses from LexisNexis and Accuity will be received over a period of 14 days. Any additional responses after the 14th day will be ad-hoc hits. Any responses received after 60 days will not create a hit. Caseworkers will select primary and secondary disposition codes on the Disposition Management tab to dispose of the hits.
Not to be used as verification unless consistent with the client-reported assets.
Updated April 10, 2023, Replacing June 10, 2019