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Wisconsin Department of Health and Family Services Income Maintenance Quality Assurance Second Party Review Manual Release 08-02 April 3, 2008 |
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Wisconsin Department of Health and Family Services Income Maintenance Quality Assurance Second Party Review Manual Release 08-02 April 3, 2008 |
Second party reviews provide an opportunity to informally evaluate and monitor policies and processes of the Income Maintenance (IM) programs.
The goals of the second party review process are to:
Establish baseline data so that program improvements can be measured,
Identify areas for cost savings and program improvement,
Maintain a focus of payment accuracy on IM programs,
Minimize workload by combining both Healthcare and FS second party review process, and
Provide an opportunity for agencies and the Bureau of Enrollment Management to work together to identify program improvement opportunities.
Goal of Targeted Reviews
The Healthcare and FS 2nd party review is a targeted review, focusing only on top error elements, not the entire eligibility circumstance for each program. Some errors may be missed in targeted reviews, however it is anticipated that targeted reviews will maximize the number of errors that can be identified and fixed without significantly increasing local agency workload. The cost-effectiveness of the targeted reviews will be periodically evaluated as part of DHFS's monitoring effort.
When completing a targeted case review determine the accuracy of the targeted elements displayed in the IMQA tool using the information available at the time of the review. Assuming that the correct data from the month under review autopopulates the review tool, a review of the accuracy of this data is sufficient to lead to the conclusion that the eligibility of the programs reviewed is correct.
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Example: Reviewer Jack selected case 1234567890 for review. This case is part of the May sample pull. The month under review is May 2008. The confirmation date is April 26, 2008.
The case was open for on-going Healthcare coverage in April. FoodShare was requested on April 14th, 2008. All needed verification was received, Eligibility was run and eligibility for both programs was confirmed on April 26, 2008. Since eligibility was confirmed after April Adverse Action, the data confirmed on April 26, 2008 did not affect May Healthcare benefits.
Note: The prorated April FoodShare allottment was $80. The April FoodShare allotment was not at least $100 therefore the case was not selected for the April review sample.
The April FS application confirmation data was the latest information available at the time the review sample was pulled. The tool displayed the updated information obtained from the April FS application. This data determined May FS and also impacts Healthcare eligibility for June forward. Even though the data was not used to determine May Healthcare benefits, any changes made to the existing data will impact Healthcare eligibility prospectively. For Healthcare, the reviewer will not be certain that the May Healthcare determination was correct, however it is more important to identify and correct future errors than it is to identify an error that occurred in the past. |
Focus on the correctness of elements in the IMQA tool in the month under review. However, if during the course of the review, an error is identified in another element, the error must be fixed
When completing a targeted review based on the above example:
Determine whether the household composition is correct for both programs with the information available at the time of the review and provided in the context of this review.
Determine whether the application for FS was processed timely, and since Healthcare is ongoing, timeliness data is Not Applicable (N/A).
Determine whether income is correct for both programs with the information available at the time of the review.
Determine whether the shelter expenses reported at the time of the review were verified and correctly entered.
Conclude on the FS and Healthcare findings screens whether the targeted elements displayed in the IMQA tool was accurate (based on information available at the time of review). If targeted elements are found to be in error, identify the affect the error would have on allotment and/or eligibility.
In the event that an error is detected by the reviewer, send the case back to the worker to correct it. The worker, not the reviewer, should look at the entire case when correcting identified errors. Reviewers are neither expected nor encouraged to verify the accuracy of elements not part of the targeted case review. Reviewers should only look at information available at the time of review, not other periods, when validating the accuracy of information displayed in the IMQA tool. The status of that review in IMQA is "In Progress” until the error identified in the targeted case review is corrected.
This page last updated in Release Number: 08-01
Release Date: 03/03/08
Effective Date: 02/01/08
