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REV. OCTOBER 29, 2019 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY

477-000-004 477-000-004 – Verification Plan/Verification and Document Guide Verification and Documentation Guide When making a determination of eligibility, it is necessary for the worker to document how the determination was made. All points of eligibility must be considered. Certain elements require verification while others require only that they be considered when determining eligibility. Throughout the process, the worker must record pertinent facts establishing why and how a particular determination was made. Verification is the process by which the worker establishes the accuracy of the client’s declaration. This is usually accomplished by viewing electronic data sources, documents, statements, or other pertinent materials which substantiate the client’s statement. Documentation is the process whereby the worker records facts pertaining to the verification process or means by which the worker establishes the point of eligibility or ineligibility. Documentation consists of, but is not limited to, the following information: 1. A description of what is being verified or considered; i.e., checking account number 123 456 7, ABC Bank; 2. A description of the source and date of verification. Example: “See bank statement from ABC Bank dated 4-10-06 in the case record. Worker received bank statement from ABC Bank on 4-12-06 for the period from 1-1-06 to 3-31-06”; 3. For a resource, description of current ownership, i.e., Mary and/or John Jones; and 4. Current value, i.e., checking account balance $5.12. For every element of eligibility, the case record must contain an explanation of how a determination regarding that point was made. In all cases the worker shall check reasonable compatibility in determining whether to use more than the minimum verifications. If the worker doubts the validity of a particular verification, s/he should investigate further and determine if a referral is needed for the Special Investigation Unit.