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MS 0870

(1)

Volume 1 – General Administration MS 0870 – R. 8/1/26 – OMTL-703 General Procedures for All Claims

[Potential claims are identified for active and inactive cases via an automatic Discrepancy Referral or a manual claim referral. For active cases, the Regional Claims Worker (RCW) responsible for reviewing claim referrals is assigned based on where the household or member lives. For inactive cases or households that have moved out of state, the RCW responsible for reviewing claim referrals is assigned based on the last region of residence where benefits were received.

A. The basic process for task creation for claim referrals includes the following:

1. During case processing, field staff process a change that creates the Discrepancy Overpayment information screen in the Integrated Eligibility and Enrollment System (IEES) or create a manual claim referral when IEES does not detect the potential overpayment.

2. Field staff create a manual Claim Referral for potential claims under the Benefit Management tab for Medical Assistance (MA), Temporary Assistance for Needy Families (TANF) related programs, Simplified Assistance for the Elderly (SAFE), and Supplemental Nutrition Assistance Program (SNAP) trafficking.

3. RCWs will receive a task for “Discrepancy Referral to Claims Worker” or a “Family Support Claim Referral Task”.

4. A Claim Referral is not considered a valid claim until it is investigated and moved from a pending claim status to an active claim status by an RCW.

Complete the following actions related to any suspected over-issuance occurring in the SNAP, SAFE, MA, Kinship Care (KC), Child Care Assistance Program (CCAP), Kentucky Transitional Assistance Program (KTAP), and KTAP-related programs administered by Family Support field staff:

B. Review the circumstances to determine the reason for the error and correct any active case. If an active SAFE case requires corrections, Central Office staff within the Nutrition Assistance Branch (NAB) must be notified via the SAFE inbox to act on the update.

C. Determine if any companion cases exist that may be affected by the potential claim.

D. After entering a change and running eligibility, if you are directed to the Overpayment Discrepancies screen, you will proceed with the following steps:

1. Scroll to the right of the screen to view all details that should be entered.

2. Select the proper method under the Detection drop-down.

3. Select the cause of the discrepancy under the Reason drop-down.