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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |328 Effective Month: December 2016 101.08.03 REQUESTING INFORMATION FROM THE APPLICANT The applicant has the primary responsibility for providing documentary evidence to verify statements made on the application or to resolve any questionable information when verification from electronic data sources is not available or is inconsistent with applicant provided statements. When additional information is needed, the following action is taken: ABD Applicants MAGI-Related Applicants

Issue DOM-307, Request for Information, to take a necessary action (such as appear for an in-person interview or apply for a specific benefit, etc.) or to request specific information that must be provided based on the ABD application responses. Request only needed verification and required actions; do not request information that does not apply.

Direct contact must be attempted before issuing a written request for information when information from electronic data sources conflicts with information provided on the MAGI application. If a reasonable explanation is provided, document the contact for the record. If direct contact is unsuccessful, document each attempted contact and issue written notice as described below.

Issue DOM-309, Second Request for Information, at the end of the DOM-307 request period for any missing information or action addressed on the DOM-307. Do not request any new or additional information on the 309; a new 307/309 is required for information or action not addressed in a previous 307/309.

Issue DOM-307, Request for Information, when needed information is not available from electronic data sources or attempts to contact the applicant by telephone are unsuccessful. List specific information needed to determine eligibility.