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West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 17 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

22.7 DATA EXCHANGE The data exchanges and matches described in Chapter 6 are applicable to the West Virginia Children’s Health Insurance Program (WVCHIP). Changes in income during the 12-month continuous period of eligibility do not affect WVCHIP eligibility unless the client becomes Medicaid eligible as the result of a decrease in income. However, information from the matches must be recorded in case comments in the eligibility system. 22.7.1 BMS THIRD PARTY INSURANCE VERIFICATION VENDOR The BMS Third Party Insurance Verification Vendor identifies creditable insurance at application for WVCHIP. The exchange of information occurs automatically as a final step after all other eligibility factors have been met.

The exchange takes place: • On an individual basis • Only during an initial application; and • Only for individuals not covered by any creditable health insurance in the system but applying for WVCHIP coverage.

This includes individuals who were previously enrolled but are now closed.

If the data exchange indicates an applicant has creditable health insurance coverage, the system will automatically code the insurance screen with the information, allowing the worker to issue a proper denial notice on an individual basis.

If the data exchange does not return creditable health insurance but it is later discovered the individual was and continues to be covered, the WVCHIP coverage must be terminated in accordance with Section 22.11.1.

Note: When reported at application or redetermination that an individual is enrolled In creditable health insurance, the Worker must enter the insurance information into the system prior to determining eligibility. This is due to the fact it is designed to only attempt the exchange in the events listed above.