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West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 10 Chapter 26 Medicaid Work Incentive (M-WIN)

26.3.5.B MRT Processing Time Limits To ensure the 90-day limit is met for MRT cases, the following time limits apply to the MRT process: Required Action Time Limit Request medical records and reports By the 7th calendar day after application Follow-up request(s) for medical records or reports By 30 days after initial request, and each 30 days thereafter Submission to the MRT By 7 days after initial request, and each 30 days thereafter Receipt of file and logged in by the MRT By 2 days after receipt by the MRT Initial review by the MRT staff By 7th day after receipt Physician's initial review By 14th day after receipt Additional medical information requested, if required, by physician By 7th day after initial physician review Physician's final review By 7th day after receipt of additional medical information Final decision and completion of ES-RT-3 By 7th day after final physicians review File returned to county office By 3rd day after final review decision Notice to the client By 7th day after receipt of final decision at county office 26.3.6 AGENCY DELAYS If the Department of Human Services (DOHS) failed to request necessary verification, the Worker must immediately send a verification checklist or form DFA-6 to the applicant and note that the application is pending. NOTE: The 90-day processing time limit concludes with the date client notification is mailed, not the date of the eligibility system action.

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Page 2134

Official source

West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 10 Chapter 26 Medicaid Work Incentive (M-WIN)

26.3.5.B MRT Processing Time Limits To ensure the 90-day limit is met for MRT cases, the following time limits apply to the MRT process: Required Action Time Limit Request medical records and reports By the 7th calendar day after application Follow-up request(s) for medical records or reports By 30 days after initial request, and each 30 days thereafter Submission to the MRT By 7 days after initial request, and each 30 days thereafter Receipt of file and logged in by the MRT By 2 days after receipt by the MRT Initial review by the MRT staff By 7th day after receipt Physician's initial review By 14th day after receipt Additional medical information requested, if required, by physician By 7th day after initial physician review Physician's final review By 7th day after receipt of additional medical information Final decision and completion of ES-RT-3 By 7th day after final physicians review File returned to county office By 3rd day after final review decision Notice to the client By 7th day after receipt of final decision at county office 26.3.6 AGENCY DELAYS If the Department of Human Services (DOHS) failed to request necessary verification, the Worker must immediately send a verification checklist or form DFA-6 to the applicant and note that the application is pending. NOTE: The 90-day processing time limit concludes with the date client notification is mailed, not the date of the eligibility system action.