Page 44

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 44 Effective Month: July 2025 learns of the death of the individual, this should be reported to the Office of Eligibility immediately. When the TPL discovers a transfer(s) during the estate recovery process, the case will be referred/sent back to the regional office. The transfer must be developed in the usual manner following transfer policy and procedures. An Improper Payment Report will be completed, if applicable, after the rebuttal process has concluded. 100.06 QUALITY CONTROL A Medicaid Eligibility Quality Control (MEQC) review on a random sample basis is required by federal regulations on all non-SSI Medicaid actions handled by the regional offices. On a monthly basis, cases are selected for review from the MMIS Recipient file using an approved sampling method. The sampled cases are assigned to a Medicaid Investigator who will: • Review the case record, make copies of pertinent material, record information on MEQC forms. • Conduct a field investigation as defined by MEQC policy. • Complete the review and make an eligibility decision based on MEQC findings and federal and state policy. The MEQC supervisor then reviews the investigator’s findings and notifies the regional office of the review outcome. A copy of the MEQC memorandum is also issued to the Bureau Director, Deputy, over the regional office and the Deputy Administrator for Eligibility. Regional Office Responsibilities The Medicaid Regional Office will: • Review the case record upon receipt of a MEQC request to ensure the electronic record is current with all appropriate documents; • Review the case record upon receipt of notice of MEQC findings to determine if there is agreement with the finding.