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3/13/20121 Filtering Options Processing The PARIS File Deuces Wild.

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Presentation on theme: "3/13/20121 Filtering Options Processing The PARIS File Deuces Wild."— Presentation transcript:

1 3/13/20121 Filtering Options Processing The PARIS File Deuces Wild

2 FILTERING OPTIONS FOR YOUR PARIS FILE Stephen Bach, New York State Office of Temporary and Disability Services, Bureau of Program Integrity Mark Zaleha, Ohio Department of Job and Family Services, Bureau of Program Integrity PARIS Training Conference March 13, /13/2012

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10 THERE’S GOLD IN THEM THAR PARIS MATCHES 3/13/201210

11 WHY FILTER PARIS DATA ? Multiple reasons Biggest reason… Maximize Productivity – Biggest bang for the buck – Greatest return on investment – Increase efficiency /13/2012

12 New York Background… Average 4.5 million recipients of TA/FS/MA at any given time. NYS has 58 counties including NYC. Over 50% of these recipients reside in NYC. NYC averages 14,000 TA/FS PARIS matches a year. Hamilton County averages.05 TA/FS PARIS matches a year /13/2012

13 NY’s Filtering Processes All Active TA/MA/FS recipients are FTP’d to DMDC. Average of 4 million records a quarter. Receive back an average of 30,000 hits. 133/13/2012

14 NY: Where Filtering Begins All matches are first checked against WRTS database to see if they are still active. All NY MA-Only matches are filtered and sent to the Department of Health for adjudication /13/2012

15 NY Filtering, continued Filter for wrong individuals matched. First three characters of first name. First four characters of the last name. If either match, process will continue. If both match, individual will continue through the process. If neither match, the match will be filtered out /13/2012

16 More NY Filtering… Filter for duplicates Any individual and case currently unresolved will not be sent out again. Any match previously resolved as “wrong individual” or “eligible for benefits” will not be sent again providing demographic info remains the same /13/2012

17 Filtering results… Of the 30,000 returned hits, roughly 12,000 or 40% are filtered out. Of the remaining 18,000 matches, roughly 12,000 are MA Only cases and sent to Department of Health for adjudication. Remaining 6,000 matches are placed in RFMS web based application for county fraud investigators to work /13/2012

18 NYC Special Filtering Filtering for geographic needs. All TA/FS individuals where the “other state” consists of a MA Only match, will be filtered out. NY does not filter based on eligibility dates /13/2012

19 NY Users Add Filters After match deployment, individual users can search and filter based on criteria. PARIS verified upon receipt. 10/14 day Closing Letters /13/2012

20 NY Financial Savings 2011 SFY 12,200 TA/FS cases = $65 Million Medicaid = even MORE $ /13/2012

21 Ohio Filtering Processes Multiple filtering at different levels PARIS file is processed by a subsystem of the PA eligibility system Final “processing” remains human involvement Different states deal with Medicaid differently – How? – Complicates filtering options /13/2012

22 Medicaid & SSI In providing Medicaid to individuals who are receiving SSI or deemed to be receiving SSI, States fall into one of three general categories: 3/13/201222

23 1634 States Referring to Section 1634 of the Social Security Act. States have a contract with SSA to determine eligibility for Medicaid at the same time a determination is made for receipt of SSI benefits. 32 states and D.C. also use the same Medicaid eligibility criteria for determining for their aged, blind and disabled SSI recipients as are used for the SSI program. CA, CO, DE, GA, FL, KY, IA, LA, ME, MO, MA, MI, MS, MT, NJ, NM, NY, NC, PA, RI, TN, TX, VT, WA, WV, WI, WY, DC /13/2012

24 SSI- Criteria States States that use the same Medicaid eligibility criteria for their aged, blind, and disabled SSI recipients as are used for the SSI program, but require that these individuals apply to the State separately from their application for SSI to determine their Medicaid eligibility based upon that application. There are 7 States that are categorized as SSI-criteria States. AK, ID, KS, NE, NV, OR, UT /13/2012

25 209(b) States States that use more restrictive Medicaid eligibility criteria for their aged, blind and disabled recipients than are used in the SSI program in one or more eligibility areas as submitted by the State's approved Medicaid plan as of Some §209(b) States do use SSI's definition of disability in determining the Medicaid eligibility of disabled individuals in their State. There are 11 States that are categorized as 209(b) States. CT, HI, IL, IN, MN, MO, NH, ND, OH, OK, VA 253/13/2012

26 Most states are 1634 and open Medicaid based on SSI. Some recipients do not realize their Medicaid case is still open when they leave the state. Since Ohio is not a 1634 state, the matches with 1634 states are a significant number. We are looking for a filter to free us from this situation /13/2012

27 Ohio’s Filtering Starts With the PARIS Submission File PARIS submission file purified – Only valid SSNs, name and DOB match – Living – Currently on assistance /13/2012

28 Ohio PARIS Return File Filtering Matching recipients must have current eligibility segment– open case in Ohio – Two months have passed since outbound file – Dismiss closed (multiple reasons) /13/2012

29 Eligibility System Filtering No eligibility date span filtering on Interstate VA source code and income discrepancy filtering on reported unearned income No filtering on Federal Income file Matched based on program priority – Highest: Medicaid, SNAP, TANF, FEA /13/2012

30 Results of Filtering Interstate – 18,575 matches reduced to 13,084 alerts – 30% decrease from matches – Many alerts are for multiple recipients in the same assistance group case (3 siblings in same case) Veteran – 5832 matches reduced to 3576 alerts – 39% decrease from matches /13/2012

31 Ohio’s Best Filters Trained eligibility workers process PARIS alerts Alerts designate PARIS match source PARIS file data is “translated” and populated to recipient data system screens /13/2012

32 32 Interstate Match Display PRMS PARIS 10/10/08 12:05 INTERSTATE MATCH WJAS J SMITH MATCH DATE: SSN: DOB: CASE: CRISE NAME: ELMER JONES CRISE ADDR: TH ST PARIS OH MATCH STATE: KENTUCKY MATCH STATE CASE NBR: A MATCH NAME: NICHOLAS CAGE MATCH ADDR: APT C 340 N MADISON ST GEORGETOWN KY MATCH STATE BEGIN: END: MATCH STATE BEGIN: END: TANF: SSI: MEDICAID: WORKER COMP: FOOD STAMPS: CHILD CARE: GA: DISPOSITION: D DISPOSITION DATE: OHIO OVERPAYMENT AMT: OHIO BENEFIT REDUCTION AMT: PF18 IQEL PF16 CONTACT INFO NEXT TRAN: ________ PARMS: ____________________________________________ *** MATCH RESULTS HAVE BEEN UPDATED /13/2012

33 33 Interstate Match Contact Information PRCT PARIS 10/10/08 12:09 INTERSTATE MATCH CONTACT INFORMATION WMAZ M ZALEHA STATE: KENTUCKY PHONE NUMBER: EXT: FAX NUMBER: ADDRESS: PF16 PRMS NEXT TRAN: ________ PARMS: ____________________________________________ /13/2012

34 Isolate the Most Productive Prioritize matches with multiple states. They tend to be the most productive /13/2012

35 VA Match Considerations Aid and Attendance benefit – Available income Third party medical coverage Possible referral to Office of Veteran Affairs Benefit address comparison Other sources of income Unreported income Vietnam Veteran /13/2012

36 Ohio’s VA Match Display Pg /13/2012

37 Ohio’s VA Match Display Pg /13/2012

38 Ohio’s VA Match Display Pg /13/2012

39 VA Enhancement Additional $4 million in savings Pull Vietnam coded veterans – File position 299, code 7 Website of agent orange related illnesses – agentorange/diseases.asp agentorange/diseases.asp Pull Medicaid diagnostic codes matching website related illnesses /13/2012

40 Agent Orange Related Illnesses Neuropathy B-cell Leukemias Diabetes Mellitus Hodgkin’s Disease Ischemic Heart Disease Multiple Myeloma Lymphoma Parkinson’s Disease Prostate Cancer…many more /13/2012

41 Federal Match Considerations Third party medical coverage Income and deductions State of residence Reported dependents and marital status /13/2012

42 42 Federal Income Match Information PRFD PARIS 08/20/08 11:15 FEDERAL MATCH WJAS J SMITH MATCH DATE: SSN: DOB: CASE: CRISE NAME: DOROTHY SMITH MATCH NAME: DOROTHY SMITH STATE RESIDENCE: MI RECORD TYPE: CIVILIAN DOD UNIT ID: AIR FORCE OFF DUTY CD: Y AGENCY CODE: DEPARTMENT OF AIR FORCE RETIRED PAY ENTITLEMENT EFFECTIVE DATE: CLAIM NUMBER: AF PAY GRADE: 04 PAY STEP: 02 PAY PLAN: ADMINISTRATIVE SUPPORT PAY STATUS: DISBURSING DATE: PAY PERIOD END DATE: CATEGORY CODE: RETIRED RESERVE EMPLOYEE STATUS CODE: WW HIRE CODE: A PAYROLL OFFICE NBR: CHARLESTON, ARMY NBR DEPENDENTS: 02 PERSONELL OFFICE ID: 0001 PAY BASIC CODE: -- MARITAL STATUS: DIVORCED GROSS PAY: FEDERAL TAXABLE WAGES: BASIC SALARY: STATE TAXABLE WAGES: TOTAL BASE PAY: FEDERAL TAX WITHHELD: STATE TAX WITHHELD: DISPOSITION: Q DISPOSITION DATE: OHIO OVERPAYMENT AMT: 0.00 OHIO BENEFIT REDUCTION AMT: 0.00 PF17 ADDRESS INFO PF18 IQEL NEXT TRAN: ________ PARMS: ____________________________________________ MORE /13/2012

43 43 Interstate Match Address Information PRF1 PARIS 09/17/08 16:46 FEDERAL MATCH WMAS M SMITH MATCH DATE: SSN: DOB: CASE: CRISE NAME: JOHN SMITH CRISE ADDR: 5555 DOVER LAKE RD WESTLAKE OH FED MAILING ADDRESS EFFECTIVE DATE: FED NAME: MARY SMITH FED ADDR: MARY E SMITH 7777 HAMETOWN RD N OLMSTED OH PF17 PRFD PF18 IQEL NEXT TRAN: ________ PARMS: ____________________________________________ /13/2012

44 MORE Filtering Options!! Only limits to PARIS filtering are those you choose within your state /13/2012

45 Michigan Filtering Active Recipients only on outbound file Return file loaded into “Data Warehouse” Filter out name mismatch – First three characters of first and last name must match – Bad match is the biggest waste of time /13/2012

46 MI Filtering That Works Re-check active status at processing Medicaid avoidance biggest ROI – Capitation fee every month, every recipient Contact, eligibility review – 60% closed month following contact /13/2012

47 MI SNAP Filtering Recipients with EBT data – Out of state usage of SNAP benefits plus PARIS match referred for review Automatic OIG reviews for MI match with more than one state /13/2012

48 QUESTIONS /13/2012


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