TN 22 (03-16)
HI 03035.006 Verification and Documentation Process for Medicare Application Processing System (MAPS)
A. MAPS verification process
We refer to information collected on the Medicare Part D Extra Help application as application data. We refer to data collected from other agencies through the matching agreements as agency data. When MAPS processes an Extra Help application, it compares the application data with the agency data.
If the application data and the agency data are in relative agreement (within certain tolerances), MAPS processes the determination and issues a notice. If the application data and the agency data are not within these tolerances, the system sends the case to the verification process. Tolerances allow for slight variations that do not affect the outcome of the subsidy level determination. In the verification process, the field office (FO) or Workload Support Unit (WSU) contacts the applicant to resolve the discrepancies between the application data and the agency data.
B. Procedure for using the MAPS verification screens and development worksheet
The system creates a verification issue on the MAPS Development Worksheet for Extra Help applications that require verification, and identifies the servicing FO or WSU. The Claims Representative (CR) requests a listing of the Extra Help applications that requires verification on the MAPS Home Page – Workload Listings (HMPG) screen and MAPS displays the verification screens. For the HMPG screen, see MSOM INTRANETMAPS 002.002.
The MAPS verification screens:
identify the issue(s) that needs to be verified (i.e., income, resources, or real property); and
provide a summary of the application data and agency data related to those issues and display fields that the CR uses to enter the verified income and resource data.
NOTE: If MAPS assigns an Extra Help application to an FO for verification, the FO should also screen for Supplemental Security Income (SSI) eligibility and complete an SSI application, if appropriate. To exclude certain SSI cases from processing time counts, see HI 03010.025B. If the individual does not wish to file for SSI, do not issue a closeout notice. The closeout is automatically included on the subsidy award or denial notice.
REMINDER: To prevent improper subsidy determinations, check and resolve all income, resources, and real property verification issues and complete the Report of Contact screen (DWRC) before submitting the application to subsidy determination.
C. Procedure for contacting the applicant
The purpose of verification is to reconcile discrepancies between the application data and the agency data and determine the correct amount of countable income and resources for the applicant. Whenever possible, complete the verification by calling the applicant or representative payee to discuss the issues. If, on the Extra Help application, the applicant requested that we contact a third party to discuss any issues, attempt to contact the third party first. If that attempt is unsuccessful or the third party cannot provide or obtain sufficient information, contact the applicant directly.
1. Contact the applicant to resolve the verification issue by telephone
When an Extra Help application requires verification, the CR should telephone the applicant as soon as possible. When contacting someone other than the applicant, use caution to avoid improper disclosure.
EXCEPTION: Do not contact the applicant if the verification issue was previously resolved. Use the MAPS DWRC screen to document that the issue was previously resolved and code the verification issue as resolved per HI 03035.006D.5.
If the telephone contact is successful, the CR should discuss the issue(s), resolve any discrepancies, and determine the correct income or resources based on the applicant’s explanation. When the applicant’s explanation for the discrepancy between the application and agency data is credible, accept the explanation and determine that the application data is the correct amount. Do not routinely request evidence to support the applicant's explanation and do not photocopy the evidence for the file.
EXCEPTION: An applicant who disagrees with the Internal Revenue Service (IRS) pension or annuity data must submit evidence to rebut the IRS data per Verification Process for Documenting Pensions and Annuities in HI 03035.012.
When contacting the applicant to resolve the verification issue:
Make two attempts to contact the applicant by telephone at different times of the day to increase the chances for making contact. Document each attempt on the Verification screen in the Report of Contact section per HI 03035.006D.2.
Enter the correct income or resources amounts on the MAPS verification screens.
If the applicant is unable to provide an explanation for the discrepancy between application and agency data, ask the applicant to provide evidence to support his or her allegation.
Record the applicant’s explanation of the difference on a DWRC screen. Follow the instructions guidelines in section HI 03035.006D.
NOTE: The agency data on the verification screen may be more than a year old due to the data matching process. The agency data does not reflect recent changes in the applicant’s income or resources. Due to the age of the agency data, the application data could be more accurate than the agency data.
2. Send evidence request notice after unsuccessful telephone contacts
After two unsuccessful attempts to make a phone contact, immediately send the Evidence Request Notice to the applicant. The CR generates this notice from the MAPS screens. In addition to serving as a request for evidence, the notice also serves as a closeout notice. For more information about the Evidence Request Notice, see HI 03010.040E.
The verification process provides an automated process for preparing the Evidence Request Notice. Use the automated features on the notice to select the type(s) of evidence needed. If the “drop down box” does not list the specific type of evidence use the “other” field to request the necessary evidence per MSOM INTRANETMAPS 006.006.
Follow the process in this list when requesting or receiving verification evidence:
When requesting evidence via the MAPS Evidence Request Notice, complete the “Issue Resolution” section of the Verification screen and diary the case for 20 days (15 days plus 5 days mail time) in the “Tickle Date” field. At the same time, complete a “Report of Contact” indicating “Verification Notice” so that the date sent matches when you sent the notice.
When the CR receives the evidence, review the evidence and determine the correct income or resources. If the evidence is not sufficient to determine the correct amounts, discuss the discrepancy with the applicant and determine the correct amounts based on a combination of the evidence and the applicant’s explanation. Document the applicant’s explanation on a DWRC screen.
When the correct amounts cannot be determined based on the applicant’s explanation and evidence is not in the applicant’s possession, ask the applicant to obtain the necessary information from a knowledgeable source to determine the correct amount (e.g., a bank for account information, an employer for wage information, a county office for property value information). Document the source and value of the item on a DWRC screen.
When the applicant can determine the correct amounts input the correct amount of income or resources on the verification screen.
When the applicant does not respond to the Evidence Request Notice by the required date (15 days plus 5 days mail time) and telephone contact is unsuccessful, deny the Extra Help application for failure to cooperate. Document the DWRC screen with the values “Verification Phone Call 1,” “Verification Phone Call 2,” and “Verification Notice” before denying the application for “Failure to Cooperate. For information and evidence closeout procedures see HI 03010.040E.
NOTE: Although the CR sent the notice because the initial two phone contacts were unsuccessful, the CR may choose to attempt additional telephone contacts if, in the CR's judgment, a telephone contact is likely to resolve the verification issue. Continue to document every attempt on a DWRC screen.
D. Procedure for completing the MAPS verification screens and documenting the verification determination
This section provides instructions to document contacts, evidence, verified data, and issue resolution within the MAPS Verification Screen sections.
1. Reviewing the agency data
When completing MAPS verification screens make sure to:
Use the Issue Verification (VRAI) screen in MAPS to resolve financial issues related to the applicant’s income, resources, and real estate information. This screen displays the available agency data for the applicant or spouse from various agencies. For the VRAI screen see MSOM INTRANETMAPS 006.006.
Use the “Current Agency Data” section on the MAPS Query (MEDQ) and the Detailed Agency Data (DADS) screen in MAPS for additional information about agency data. For the MEDQ screen, see MSOM INTRANETMEDQ 001.001. For the DADS screen, see MSOM INTRANETMEDQ 001.009.
Review the MEDQ and DADS queries to get the specific source of agency data for income and resources displayed on the verification screen when developing a verification issue on the VRAI screen. This information helps in asking the appropriate questions when resolving verification issues with the applicant.
Follow processing instructions in HI 03035.010E when an application selected for verification has “Other Unearned Income” reported and the DADS screen has no corresponding detailed agency data.
2. Completing the report of contact section
To record contacts with the applicant or other persons during the development of verification issues, use the Report of Contact (DWRC) screen per MSOM INTRANETMAPS 006.003.
Take the following steps to record contact with the applicant:
Use the drop-down box to indicate whether the contact was by phone, in-office visit, a notice or other.
NOTE: If you chose “Other,” document, the type of contact made to resolve the issue(s).
Document the screen with the name of the person contacted and a summary of the discussion in the “Comments” field (e.g., “Bank account was closed November 2006; application data is correct”). Explain the discrepancy between application data and agency data. Record any pertinent explanation that supports the resolution of each verification issue on the record. The system generates the dates of the phone contact.
Complete the documentation for all verification issue resolutions, including why the claims representative did not use the income and resources from the agency data displayed on the VRAI screen in MAPS. This documentation is the only evidence that the CR properly developed the income and resources and used the correct income and resources to determine the Extra Help eligibility. Statements such as “Done” and “Verification Complete” are not sufficient.
Document the contact on a DWRC screen and the rationale for the Extra Help determination. Choose the Contact Subject value “Verification Completed” on a DWRC screen before resolving the verification issue and submitting the application for an Extra Help determination. The drop down list on the MAPS DWRC screen contains the Contact Subject value, “Verification Completed”.
IMPORTANT: You must select this value on the DWRC screen before MAPS can resolve a verification issue.
Prepare and mail the Evidence Request Notice in MAPS after two unsuccessful phone attempts to resolve the issue To complete the report of contact history see MSOM INTRANETMAPS 006.006. Select the Contact Subjects “Verification Phone Call 1,” “Verification Phone Call 2,” and “Verification Notice” from the drop down box on the DWRC screen to document each attempt to contact the applicant and that the notice was sent.
Complete the “Issue Resolution” section of the Verification Screen when requesting evidence via the MAPS Evidence Request Notice and diary the case for 20 days (15 days plus 5 days mail time) in the “Tickle Date” field. At the same time, complete a “Report of Contact” indicating “Verification Notice” so that the date sent matches when you sent the notice.
Document the DWRC screens if the applicant has not provided the requested information to SSA by the due date, document the DWRC screens with the values “Verification Phone Call 1,” “Verification Phone Call 2” and “Verification Notice” before denying the application for Failure to Cooperate (For information and evidence closeout procedures see HI 03010.040E).
NOTE: When users attempt to resolve a verification issue without documenting the verification determination on a DWRC screen with the Contact Subject value “Verification Completed,” MAPS displays this edit, “Report of Contact mandatory to document verification results,” per HI 03035.006D.2.
3. Completing the evidence requested section for a notice
Use this section to generate the Evidence/Information Request Notice.
To complete the Evidence/Information Request notice take the following steps:
Select the types of evidence requested on the notice from the drop-down box. The “Details” field provides a description of the evidence (e.g., mortgage statement for the property on 123 Main Street). This section keeps a record of the evidence requested and the date.
Record the date that you received the evidence in the “Receipt Date” field.
Document the information received on the “Comments” section of the DWRC screen. Summarize the evidence used to resolve the issue (e.g., “Reviewed 07/08 statement from Ninth National Bank; balance $1,230.75”).
Do not photocopy evidence for the file and do not fax evidence into an electronic folder.
4. Completing the issue information section
Enter the following information in this section to correct income or resource amounts:
Enter the correct amount(s) of income or resources for the individual. This section displays application data and agency data for the types of income and resources collected on the Extra Help application.
Select either “None,” “Application,” “Agency,” or “New Amount” as the correct amount to be used for the Extra Help eligibility determination. If you select the “Not Verified Amount” button, the information must be verified with the applicant and the button changed to either “None,” “Application,” “Agency,” or “New Amount.”
Use the income fields labeled “work-related expenses” to correct the amount of work expenses when the individual establishes that actual expenses are greater than the 16.3 percent Impairment-Related Work Expenses (IRWE) exclusion or the 25 percent Blind Work Expenses (BWE) exclusion automatically computed by the system. (For instructions on determining and entering the actual value of IRWE or BWE, see HI 03020.030.)
NOTE: The “Work Expenses for Disability and Work Stop Date” (ATWE) screen now allows you to over key the default IRWE or BWE amount computed by the Subsidy Determination (SD) process. After answering “yes” to the work expenses question, you can select the “Calculate IRWE or BWE” button. Selecting this button calls the IRWE or BWE calculator in SD and displays the default IRWE or BWE amount based on the total yearly income. If this amount is over-keyed, SD uses the over-keyed amount in its final determination of the IRWE or BWE amount.
5. Completing the issue resolution section
The system computes eligibility or ineligibility for the Extra Help after the CR completes the verification and selects one of the issue resolution buttons.
NOTE: This section shows status as “pending” until verification is complete.
Select one of the issue resolution buttons when the CR completes the verification issues:
Select the “Resolved” button when the verification is complete and the Extra Help application is ready to submit for a subsidy determination.
Select the “Failure to Cooperate” button if attempts to contact the applicant are not successful and the closeout period has elapsed.
Select the “Cancel Application” if it is necessary to cancel the application and begin a new application
6. Verification screen buttons
The following information explains the verification screen buttons needed to navigate the verification process:
The “Save” button allows the CR to save data and remain on the verification screen.
The “Save and Return” button saves data and returns the CR to the home page.
The “Submit to Subsidy Determinations” button saves data, submits the completed verification for a determination, and returns the CR to the home page.
The “Cancel” button deletes all data that the CR entered and returns the CR to the developmental worksheet.
E. Medicare Part D Extra Help application examples for documenting verification resolutions
Here are two case examples that illustrate how to document verification resolutions.
Example 1 – Verification development where the CR determines not to use the agency data displayed on the Verification screen
Lucy White filed for the Medicare Part D Extra Help on January 25, 2009. When the Wilkes-Barre Data Operations Center (WBDOC) technicians scanned the SSA-1020-OCR (Application for Extra Help with Medicare Prescription Drug Plan Costs), no exception issues were created. However, MAPS selected the application for verification because the other agency data shows other pension income of $138.00, stocks and bonds of $5,877.00, and gross distribution of $2,500.00. After telephoning the applicant, the CR resolves and documents the verification issues as follows:
Documentation in Report of Contact (DWRC) Screen
(IRS data for tax year 2007)
NOTE: The IRS data was $1,656.00 and MAPS divided it by 12 and posted the monthly amount of $138.00
Contacted applicant Lucy White to ask about the other pension amount of $138 not reported on the application. Applicant explained she received $138 per month pension payment that ended in March 2008. Because this is pension income, the CR must request proof that the payments have stopped and document evidence per HI 03035.012
Stocks and Bonds
(IRS data for tax year 2007)
Lucy White stated that she sold her stocks in 11/2008 to buy a car. She has not purchased any more stocks since then.
Contacted applicant Lucy White to ask if the IRS data was for retirement account, a pension or an annuity. Applicant explained she received a withdrawal from her 401(k) plan. We count Retirement accounts and withdrawals from retirement accounts as resources. The CR must request the balance of the 401(k) account and follow the verification and documentation instructions in HI 03035.007A.3.
Example 2 - Verification development where the CR determines to use a “New Amount” on the Verification screen
Gloria Lee filed for the Medicare Part D Extra Help on March 16, 2009. MAPS selected her application for verification because the agency data shows the IRS-1099 information with interest income that indicates a bank account balance of $14,750.00. Ms. Lee did not report the bank account information on the application. The CR documented the telephone discussion she had with Ms. Lee later that month as follows:
Documentation in Report of Contact (DWRC) Screen
(IRS data for tax year 2007)
Contacted applicant Gloria Lee to ask about the bank account information of $14,750 listed in Agency Data not reported on the application. Ms. Lee explained that she forgot to report the bank account information on the application and provided the current account balance.
HI 03035.005 Verification Policy within the Medicare Application Processing System (MAPS)
HI 03035.007 Verification and Documentation Instructions for Internal Revenue Service (IRS) Data within the Medicare Application Processing System (MAPS)
HI 03035.008 Chart with IRS Transaction Types for Medicare Application Processing System (MAPS) During the Verification Process
HI 03020.055 Income Limits for Subsidy Eligibility
HI 03035.010 Income Verification Process
HI 03035.020 Verification Process for Liquid Resources
HI 03035.030 Verification Process — Real Property