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MS 0810

(1) Volume 1 - General Administration MS 0810 - R. 8/1/26 - OMTL-703 How to Identify a Claim

A. [Identification of claims is an automatic process if an overpayment is detected by the Integrated Eligibility and Enrollment System (IEES) during case processing. For example, field staff make appropriate case changes and IEES detects a potential overpayment. At disposition, an automatic Discrepancy Referral information screen is triggered. Field Staff can create an overpayment discrepancy task for the Regional Claims Worker (RCW) to review from this screen. All other claims are manually referred.

B. A Manual Claim referral is created when the following occurs:

1. Supplemental Nutrition Assistance Program (SNAP) benefits are trafficked;

2. Benefits designated for a specific purpose are used to purchase unapproved items or services;

3. Claims identified as occurring prior to implementation of IEES and were not processed on Kentucky Claims Debt (KCD) Management System;

4. Medicaid Fraud;

5. Individual Child Care Fraud;

6. Child Care Provider Fraud;

7. Some supportive service payments are overpaid; or

8. When any overpayment is detected by field staff that is not automatically detected by IEES.

C. When completing a claim referral or while establishing a claim, staff will utilize one of the following detection code associated with how the claim was identified:

1. Batch Match/Computer Match: Used when computer file data from the Income and Eligibility Verification System (IEVS) is matched against case and member information on Worker Portal and the discovery of unreported income/resources results in an overpayment or incorrect issuance of benefits for all Family Support assistance categories;

2. Public Assistance Reporting Information System (PARIS): Used when a recipient match is received showing benefits were issued in more than one state for the same timeframe;

3. Hotline: Used when an overpayment is found due to a citizen, known or anonymous, contacting the Food and Nutrition Administration (FNA) through a Whistleblower Complaint or the Office of Inspector General