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change was not reported on an Interim Report received 2/2. The claim would be calculated using 4/28 as the discovery date and the claim opened as type PPV. An Administrative Disqualification Hearing decision was received on 12/3, indicating an IPV. The discovery date would then be changed to 12/3 per the IPV rules for discovery date and thorough case notes would be used to explain the change in discovery dates.

Note: A claim is considered “open” when the client has been notified of the overpayment. 4615.15.00 PENDING CLAIM REFERRAL TIME PRIORITIES

A QC pending claim referral is to be completed within 30 days of the assignment if possible. All months affected by the QC discrepancy must be reviewed and included in the claim or restoration. The discovery date is per the rules above for AE, IHE, and PPV claim types. The remaining pending claim referrals will be worked per business rules, always working referrals on any open cases before those referrals on closed cases. 4620.00.00 COMPLETING THE BENEFIT RECOVERY REFERRAL

If it is discovered that an over-issuance has been made within the time frames noted in 4615.00.00, the eligibility worker is to complete the Benefit Recovery Referral including comments. Refer to Section 4605.05.00. 4620.05.00 ASSIGNING THE REFERRAL TO THE BENEFIT RECOVERY WORKER

After a Benefit Recovery referral has been made, a task is generated to the Benefit Recovery Unit. All claim referrals are to be assigned to a Benefit Recovery Worker within ten working days of the referral date. 4620.05.05 OVER-ISSUANCE CALCULATION

The BV worker is to complete a budget for each month an over-issuance is identified using the claim calculator. Calculations to determine over-issuances must be in accordance with eligibility requirements and budgetary procedures and allowances in effect at the time of the over-issuance (not at the time of discovery and computation). 4620.05.05.05

DETERMINING THE FIRST MONTH OF OVER-ISSUANCE (C)

The determination of the first month of over-issuance is based upon: • when the AG had knowledge of the change; and • the eligibility worker’s requirement to act upon reported information.