HPE APPLICATION PROCESS Sample Clauses
HPE APPLICATION PROCESS. 11.1 All HPE applications must be created and processed in HEAplus.
11.2 The Hospital is encouraged to complete a full Medicaid/AHCCCS application in HEAplus and use the HPE option only if the full Medicaid/AHCCCS application is not immediately approved by HEAplus because additional verification is required from the applicant or that a state worker needs to review the application.
11.3 If the Hospital begins a full Medicaid/AHCCCS application in HEAplus and the data hub results indicate that the applicant is over income for Medicaid or does not meet citizenship/immigration or residency requirements, the Hospital worker may not begin a HPE application for that individual.
11.4 If the applicant is unable or unwilling to provide all of the necessary information to submit a full application, the Hospital worker may begin the HPE application in HEAplus entering the required data elements.
11.5 The Hospital worker can make a HPE determination and provide notice of approval to the applicant only when the information the applicant provides and the Hospital worker enters in the HPE application indicates the applicant is eligible.
11.6 An applicant can be approved for HPE even when the information the applicant attests to cannot be verified by the state and federal data services and the applicant does not have the verification available at the time of application.
11.7 The Hospital worker must obtain the HPE applicant’s signature on the HPE Application Summary attesting that the information entered on the HPE application is complete and correct. This is required for Program Integrity reviews to assist the AHCCCS OIG in audit reviews as well as connecting the HPE application to the completed full application.
11.8 A full application Medicaid/AHCCCS submitted after the HPE application must ONLY be submitted in HEAplus by the Hospital worker so that the agency can connect the HPE application to the full AHCCCS application.
11.9 All HPE determinations will be electronically transmitted from HEAplus to the AHCCCS Online website and to OIG.
11.10 When a full AHCCCS application is not submitted at the same time as the HPE application, the Hospital must offer the applicant a follow-up appointment to complete the full AHCCCS application.
11.11 The Hospital must provide the applicant with a HPE decision in accordance with this agreement.