ES State Processes
December 2013
Eligibility Services
State Processes
Effective December 2013
ES State Processes
I.
II.
III.
IV.
December 2013
Introduction
Access Channels
General Expectations
HHSC Eligibility Office
Application Registration and Scheduling Tasks
Applications/Redeterminations - Received by HHSC Eligibility Office
Application/Redetermination – Interview Required or Requested
Application/Redetermination – Interview Not Required or Requested
Scheduled Interviews
Missed Appointments
Reschedules
Desk Review
Children’s Health Insurance Applications/Redeterminations
V.
Customer Care Center
Agency Generated Changes
Date Of Death (DOD) Alert Processing
Enrollment Broker Expection Task
Changes Reported via OIG
Failure to Return Review Packet (091 Denials)
System Denial Task
SNAP Terminated Task
Duplicate Applications
Client Reported Changes
Changes Reported via OIG
Returned Undeliverable Mail
VI. Texas Women’s Health Program
Texas Women’s Health Program (TWHP) - Applications
Texas Women’s Health Program (TWHP) – Redeterminations
Pregnant Women Medicaid Applications
VII. Centralized Benefit Services
MTFCY Application/Redetermination Processing
FFCC Application Processing
MTFCY/FFCC Exception Task
HC-FFCHE Request for Review Task
SNAP – SSI Application/Redetermination Processing
Simplified Nutritional Assistance Program (SNAP - CAP) Processing
Medicaid for Breast and Cervical Cancer Processing
RMA Processing
TYC/TJPC Applications
Medicaid for Inmates of a Public Institution Applications
CBS Disposition Tasks
VIII. Medicaid for the Elderly and People with Disabilities
MEPD Applications
MEPD Interview Requested
MEPD Redeterminations
Reschedules
LIS MSP Application Processing
Medicaid Buy-In (MBI)
Medicaid Buy-In for Children Processing
MEPD Referrals
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ES State Processes
MEPD Regional Change Processing
Date Of Death (DOD) Alert Processing
MEPD Disposition Tasks
Failure to Return Review Packet
Duplicate Applications
Additional Processes
IX.
Outstationed/Facility Workers
MEPD Processing
MEPD Facility Requests
Texas Works Processing
X. Central Processing Center
CHIP Perinatal Form H3038P Process
XI. Centralized Representation Unit
Fair Hearings Processing
XII. CHIP Request for Review (RFR)
Request for Review Processing
Request for Continued Enrollment Processing
XIII. Data Integrity
Change for a MEPD-SSI Case TLM task
Freeze Flag Alerts
ME SSI Manual Certifications
Medicare Buy In
QI-1
Managed Care
Newborn Eligibility
Merge & Separate
Biographical Corrections
XIV. ES CBO Regional Office
‘Assisted’ Applications/Redetermination Processing
‘Interviewed’ Application/Redetermination Processing
CBO Documents Submission
ES CBO Contacts
XV. General Processing
Duplicate Applications
Identical Applications
Client Reported Changes
Client Inquiries
Complaints
Missing Information - No Anchor Task
Fair Hearings Requests
Handling of Inappropriate Documents
Disaster SNAP Processing
SSP Account Management
Escalating Vendor Processing Issues
Automatically Routed Tasks
TIERS Alerts
TIERS Unavailable
Texas Health Steps Verification Process
TIERS Case Assignment
Reporting TIERS/State Portal Tickets
Escalation of TIERS Tickets
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ES State Processes
Help Desk Ticket Processing Issues
Data Broker Resolution
Task Failure Processing
XVI. Support Tools
Document Routing Procedures
Complete Action and Disposition Coordination
Document Upload
First Time Sign-On Procedure for State Portal
Ordering ES Materials
Re-Linking Images
State Portal Supervisor
State Portal TLM
TIERS/Portal Security Roles – MOR Workload Transfer
Escalated Ticket Template
Self Service Portal Application Registration
Reminders
XVII. Glossary of Terms
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ES State Processes
I.
December 2013
INTRODUCTION
This document focuses on internal state processes and it is designed to identify the core
responsibilities of state staff and to further document the processes within those
responsibilities. It also provides basic information on key vendor functions. While
automation is integral to the overall functioning of eligibility determination and case
maintenance in the Texas Integrated Eligibility Redesign System (TIERS), the main
focus is on the responsibilities of state eligibility determination staff (workers, clerks and
management).
The role of the state is to collect, review and ensure the accuracy and completeness of
data collected by the vendor. State staff conducts interviews, process changes,
determine client eligibility, process request for reviews, process appeals request, and
serve as the agency representative for fair hearings. State staff and vendor staff use a
work-flow mechanism called "Task List Manager" that is accessible through a common
web-based State Portal. This software allows task to be created, claimed, comleted and
monitored by staff based on their user roles.
This material is divided into ten main work areas: Eligibility Offices, Customer Care
Centers (CCC), Assistance Response Team (ART), Medicaid Eligibility for the Elderly
and People with Disabilities (MEPD), Outstationed, Children’s Medicaid Centers (CMC),
Women’s Health Program (TWHP), Central Processing Center (CPC), Centralized
Benefit Services (CBS) and Performance Improvement. ES State Processes cover the
procedures unique to those areas and those that cross areas. It also contains
terminology related to the Eligibility Support Services process.
Included at the end of this document are several Support Tools that are designed for
quick reference.
Note: Staff must continue to follow all policies and procedures located in
the TW and MEPD Handbooks.
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ES State Processes
II.
December 2013
ACCESS CHANNELS
Access channels are various ways TIERS clients can apply for benefits, check the status
of submitted applications, report or check the status of a change and several other
options. These channels provide clients options when seeking assistance. Access
channels include telephone, fax, mail, Internet and in person at the Eligibility Offices.
Telephone Call (2-1-1)
A caller has four services available when dialing the 2-1-1 phone number:
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Option 1 - Information and Referral (local community services)
Option 2 - Eligibility (Vendor/Customer Care Centers)
Option 3 - Office of Inspector General (OIG) to report fraud/benefit abuse.
Option 4 – Register for evacuation and transportation assistance
Once a call enters the 2-1-1 phone system, the caller must choose which services they
need to access. An Interactive Voice Response (IVR) system prompts the caller for
language and services, then routes the call accordingly.
The IVR Options Menu is provided below for informational purposes.
Option #1: Information and Referral, staffed 24 hours a day, 7 days a week by the local
Area Information Center (AIC), provides information about all health and human services
available in the community. Callers seeking help can obtain referrals regarding, but not
limited to:
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Immediate needs services such as shelters and food pantries
Other state and federal agencies
Child care concerns
Other community services offered
Option #2: Eligibility provides information regarding State benefits and the ability for
callers to apply for Texas Works or MEPD services. Services available by phone
include:
 Applying for benefits (excluding FS)
 Screening for expedited food stamp eligibility
 Checking the status of applications or benefits
 Reporting changes
 Requesting fair hearings
 Rescheduling interviews
 Responding to Missing Information letters
 Checking the status of documents received by HHSC
 Updating their phone number
Option #3: The OIG selection routes callers to state staff who accept and investigate
reports of fraud and benefit abuse.
Option #4: Allows individuals to register for evacuation and transportation assistance in
the event of a disaster.
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ES State Processes
December 2013
Fax & Mail
Applications received by the vendor via fax and mail, are processed according to the
programs requested on the applications. Clients, authorized representatives,
Community Based Organizations, and Eligibility Offices can fax and mail documents and
applications directly to the vendor according to the Document Routing Procedures –
TIERS Offices.
Internet (SSP)
The Self Service Portal (SSP) located at: www.yourtexasbenefits.com is available to
TIERS clients 24 hours a day, 7 days a week. They can use this website to check the
status of documents submitted to HHSC, submit applications, submit redeterminations,
report changes, check the status of their benefits, and check future appointments.
HHSC Eligibility Office
All documents received by the HHSC Eligibility Office are date stamped, reviewed for
completeness and processed according to the guidelines for programs requested. They
are routed to the vendor when appropriate. Applicants will be given a receipt for any
documents submitted in person or by mail at an Eligibility Office.
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ES State Processes
III.
December 2013
GENERAL EXPECTATIONS
Consistency is essential to the success of the Eligibility Support project. Therefore, state
staff must follow these processes as closely as possible.
The ES State Processes are designed to provide guidance for day-to-day activities.
Although the intent of the procedures are to address common activities, there may be
times when it is necessary and appropriate to seek guidance from management and/or
follow established local office procedures.
As a result of ES, many activities have become centralized. The primary centralized
functions include:
 Document Processing
 Eligibility Determination for certain programs (both new applications and
redeterminations)
 Change Processing
 Client/Applicant General Inquiry Support
 Fair Hearings Processing
 Request for Review Processing
Vendor responsibilities include the following:
 Document imaging
 Image assembly and case association
 Responding to client inquiries and questions from 2-1-1
 Rescheduling appointments using the State Portal Scheduler
 Accepting client reported changes
 Updating mailing addresses
 Routing work through State Portal and creating tasks appropriately for Texas
Works and MEPD activities
 Routing and escalating complaints and fair hearing requests
 Routing Request for Reviews
 Enrollment Broker for CHIP/CHIP Perinatal
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ES State Processes
IV.
December 2013
HHSC ELIGIBILITY OFFICE
The Eligibility Offices are state offices where clients will be issued benefit access
instruments and participate in ‘Face-to-Face’ or ‘Telephone’ interviews when applicable.
Clients will also receive services from workers for ‘Home Visit’ interviews.
The Eligibility Office staff will be responsible for several key activities, including, but not
limited to:
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Issuing benefit access instruments (e.g. EBT cards, temporary
Medicaid IDs).
Performing identification verification and capturing biometric data (e.g.,
photographs).
Conducting Face-to-Face, telephone and home visit interviews via a
scheduled appointment.
Completing Application Registration (App Reg) for applications when
necessary.
Completing all work end-to-end through final case disposition.
Publishing Office Capacity at least 60 days out.
Maximizing published appointment slots in the State Portal Scheduler for
applications, expedites and redeterminations to allow the office to schedule
and reschedule clients through the portal as needed. This will also allow the
vendor staff to reschedule clients.
Managing/monitoring office capacity and lead time daily to ensure
application/redetermination processing timeframes are met according to
policy guidelines.
Scheduling and rescheduling appointments for applications, expedites and
redeterminations through the State Portal Scheduler.
Application Registration and Scheduling Tasks
Prior to linking a mailed or faxed application to a case, the vendor will perform inquiry to
determine if Application Registration is required and will initiate an Application
Registration TLM task for processing. In addition, when clients submit an on-line
application via yourtexasbenefits.com, an Application Registration TLM task will be
routed to a state global queue based on the household’s residential zip code or the
program type (See State Portal Support Tool: Task List Manager (TLM).
The following Application Registration tasks are sent to a state TLM global queue:
 ‘Process a SSP Application Registration‘
 ‘Process an Expedited SSP Application Registration’
 ‘Process an Application Registration’
 ‘Process an Expedited Application Registration’
 ‘Process an Application Registration for Form 3038P’
Note: The Application Registration page in TIERS for a Self-Service Portal
application will be pre-filled with data submitted via the
www.yourtexasbenefits.com website.
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ES State Processes
December 2013
Designated staff will perform Application Registration in TIERS and establish a case
number. If an interview is required or requested, staff must schedule the appointment
using the State Portal Scheduler. TIERS will initiate the appropriate ‘Process Task’ at
the completion of Application Registration if an appointment is not required or requested.
If the vendor determines that the household has an existing TIERS case and Application
Registration is not needed, the appropriate ‘Process Task’ will be routed to the state as
they are today. If an interview is required or requested, the vendor will send a
scheduling task. The task will be routed to a state global queue based on the
household’s residential zip code or the program type. See State Portal Support Tool:
Task List Manager (TLM) for additional information.
The following scheduling tasks are sent to a state TLM global queue:
 ‘Schedule an Application Interview’
 ‘Schedule an Expedited Interview’
 ‘Schedule a Redetermination Interview’
Applications/Redeterminations - Received by HHSC Eligibility Office
Applications/Redeterminations received in the Eligibility Offices are date stamped and
screened for completeness and appropriate routing. Eligibility Offices are responsible
for end-to-end processing of all Texas Works (TW) applications/redeterminations
received in the Eligibility Offices that require or request an interview. Responsibilities
include performing Application Registration, scheduling and completing all initial
applications and redeterminations end-to-end.
Application/Redetermination – Interview Required or Requested
The following describes the appropriate processing for applications/redeterminations
received in the Eligibility Office and an interview is required by policy or the interview is
requested by the client (Food Stamps/TANF/TW Adult Medicaid).
Once the application/redetermination screening steps are finished, staff must perform
the following activities.
 Complete Application Registration, if necessary.
 Schedule the application in the office via the State Portal Scheduler
according to program type and policy timeframes.
 Provide the client with Form H1830 - Application/Review/
Expiration/Appointment Notice.
 Process the case action end-to-end through final disposition including all
associated programs.
 Process all TLM tasks appropriately.
 Mail all applications/redeterminations and supporting documents to Midland
for imaging once final case action is taken and case is disposed. One Image
Only cover sheet must be attached to each client packet.
 Complete appropriate forms to issue access to benefits when necessary.
 Issue EBT cards or Medicaid letters when necessary.
 Maintain communication with client as needed to process case actions.
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ES State Processes
December 2013
Note: If a non-expedite application or redetermination is received in the
incorrect office, staff should follow the Document Routing Procedures –
TIERS Offices and mail or fax it to the vendor for processing.
Application/Redetermination – Interview Not Required or Requested
The following information describes the appropriate processing/routing for
applications/redeterminations received in the Eligibility Office and the requested program
does not require an interview and the client has not requested an interview. These are
organized by type of assistance because routing is different.
Note: If the household is applying for multiple programs and any of the
programs require an interview (i.e. application for Food Stamps and CMA),
the application remains in the office for scheduling according to TW
program policy timeframes. All programs must be processed end-to-end.
Scheduled Interviews
Applications/Redeterminations received in the Eligibility Offices are scheduled according
to the type of assistance requested and TW program policy timeframes. Scheduling the
appointment generates a task in the Eligibility Office TLM Global Queue. This section
describes the Eligibility Offices processes and all activities that require an interview
(Face-to-Face, Telephone, or Home Visit) and for clients who have requested interviews.
These activities are processed end-to-end.
The following task types are sent to the Eligibility Office TLM Global Queue based on the
interview type:
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Face-to Face: ‘Check In a Face-to-Face Interview for a (Program)
Application’ or ‘Check In a Face-to-Face Interview for a (Program)
Redetermination’
Telephone: ‘Check In a Telephone Interview for a (Program) Application’ or
‘Check In a Telephone Interview for a (Program) Redetermination’
Home Visit: ‘Check In a Home Visit for a (Program) Application’ or ‘Check In
a Home Visit Interview for a (Program) Redetermination’
Missed Appointments
Whenever a client missing their scheduled appointment and the appointment task is
marked as a ‘No Show’ one of the tasks below will be created:
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Face-to Face: ‘No Show on a Face-to-Face Interview for a (Program)
Application’ or ‘No Show on a Face-to-Face Interview for a (Program)
Redetermination’
Telephone: ‘No Show on a Telephone Interview for a (Program) Application’
or ‘No Show on a Telephone Interview for a (Program) Redetermination’
Home Visit: ‘No Show on a Home Visit for a (Program) Application’ or ‘No
Show on a Home Visit Interview for a (Program) Redetermination’
ES State Processes
December 2013
Note: SNAP ‘No Show’ tasks will be flagged indicating automatic denial
will occur on the associated EDG. Once the SNAP EDG is denied, based on
policy, the associated TLM task will be automatically closed. The TLM will
automatically create a task when other programs exist at the time of auto
denial. When no other program exists and TIERS denies a SNAP EDG but
the case is not in ongoing mode due to a case data change, a ‘Process a
Change for a System Denial’ change task will be created and routed to the
CCC.
Note: DO NOT process missed appointments for programs that do not
require interviews even if the client requested an interview, but failed to
appear.
Reschedules
Requests for rescheduled appointment will be processed by the entity who receives the
request. For instance, clients who request a rescheduled appointment through 2-1-1 will
be rescheduled by the vendor staff. Individuals who contact the Eligibility Office to have
their appointment rescheduled will be rescheduled by designated staff in that office.
Note: Vendor staff can only process a reschedule if the original
appointment was scheduled through the State Portal Scheduler. If the
original appointment was not scheduled through the State Portal, they will
refer the client to the eligibility office for rescheduling.
Staff authorized to reschedule appointments must access the State Portal Scheduler to
perform this task and must follow reschedule policy guidelines.
Reschedule – Agency Error
In the event a client is available to participate in a scheduled appointment but the
worker/office is unable to process the interview, the appointment must be rescheduled.
The process below outlines the steps staff need to follow when handling these
reschedules due to agency error.
1. Appropriate staff marks the appointment task as “Show”.
2. Worker claims the “Show” task and completes the task as ‘Not Held – Agency
Fault’. This task completion option will create a rescheduling task for the
office.
Note: Staff can also complete the Check-in task as “Not Held – Agency
Fault” to create a reschedule task.
3. Designated staff claims the ‘Reschedule Face-To-Face Appointment for a
(Program – Application/Redetermination)’; ‘Reschedule Home Visit Appointment
for a (Program – Application/Redetermination); or ‘Reschedule Telephone
Appointment for a (Program – Application/Redetermination)’ task.
4. Designated staff reschedules the client through the State Portal Scheduler,
setting the “Why is this appointment being rescheduled?” field on the
Schedule Appointment page to ‘Agency fault or request’. Once the
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ES State Processes
December 2013
appointment is rescheduled, the reschedule task will be automatically
completed.
Note: Vendor staff will delay rescheduling telephone appointments when
the reschedule request is received on the day of the appointment and the
request is due to no contact by the eligibility staff at the designated
appointment time. Instead, vendor staff will ask the applicant/client to call
the following day to reschedule the appointment if the eligibility staff does
not contact them to conduct the interview on the appointment date. This is
to allow eligibility staff an opportunity to contact the client/applicant
throughout the day of the scheduled appointment to conduct the interview.
End-to-End Processing (Including MI Received)
Workers are responsible for processing all cases/EDGs end-to-end. Therefore, as tasks
are received it is important to monitor the tasks for all EDGs associated with the case.
Tasks should remain open until all associated EDGs are processed, and should not be
completed prior to the task Due Date. For tasks with multiple EDGs, the EDG with the
earliest due date is displayed.
MI Received
If missing information is received by the vendor, staff will see an open envelope icon on
the TLM task. If the icon is present, the worker uses the Case Data Search feature in
the State Portal to look for missing information images. The worker enters the
information in TIERS Data Collection and runs eligibility to complete the case. After
eligibility is run, the worker reviews results for accuracy.
If missing information is received at the local office, staff will perform inquiry to determine
the worker. If it is a worker in that office, it will be routed to that worker for processing. If
the information belongs to someone who is not in the local office, staff completes an
MI/Change Routing cover sheet and then the information will be faxed to MI/Change
Routing fax line and the system will route the information appropriately.
Fax to:
1-877-236-4123
Desk Review
Applications/Redeterminations
When HHSC receives a food stamp application or redetermination, a ‘Schedule an
Interview for an Application or Redetermination’ task is created that informs the local
office to schedule an interview.
The task will have a ‘Desk Review’ completion option in addition to other current
completion options if the application/redetermination potentially meets the following
conditions:
 The task programs include FS,
 The task programs do not include TANF or MA,
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ES State Processes
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December 2013
The associated case includes a FS EDG with a recertification status of Review
Ready (RR) or Review Initiated (RI),
The associated case does not include approved or pending TANF or MA EDGs,
The associated case does not include a pending program request for TANF and
The previous Food Stamps certification or recertification was not conducted with
an appointment as recorded in TIERS marked as a desk review.
Scheduling staff will follow the steps below to create a ‘Desk Review for a (FS/Combined
TW) Application or Redetermination’ task.
1. Screen application/redetermination to determine if it meets the Desk Review
policy.
2. If it meets the requirements, scheduling staff will select the ‘Desk Review’
completion option. This will result in the ‘Schedule an Interview for an
Application or Redetermination’ task being closed and the Task List Manager
(TLM) will create a ‘Desk Review for a (FS/Combined TW) Application or
Redetermination’ task for the office.
3. The worker will retrieve the ‘Desk Review for a (FS/Combined TW) Application
or Redetermination’ and process according to policy.
Note: Staff should following local office procedures in the assignment and
completion of the ‘Desk Review’ tasks.
Applications Received by Eligibility Office
If a FS application or redetermination is received by the eligibility office and it meets the
desk review criteria, the following steps should be taken:
1. Scheduling staff should access the State Create Task page and manually
create a ‘Desk Review for a (FS/Combined TW) Application or
Redetermination’ task for the office.
2. The worker will retrieve the ‘Desk Review for a (FS/Combined TW) Application
or Redetermination’ and process according to policy.
Note: Staff should following local office procedures in the assignment and
completion of the ‘Desk Review’ tasks.
The TIERS automation changes restrict the ability of workers to select Desk Review as
the value for the Appointment Mode field on the Appointment Details page only when
the following criteria are met:
 The associated case currently does not include any approved or pending TANF
or Adult Medicaid EDG (TP08),
 The associated case currently does not include a pending TANF program
request,
 The associated case currently includes a SNAP EDG with a recertification status
of Review Ready (RR) or Review Initiated (RI).
 The previous SNAP appointment was not conducted as a desk review and
 The appointment does not include TANF and does include SNAP.
In addition, TIERS defaults the value of the Appointment Status field on the
Appointment – Details screen to ‘Show’ and disables the field for input if the
Appointment Mode field is set to ‘Desk Review’.
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ES State Processes
December 2013
Children’s Health Insurance Applications/Redeterminations
State workers in centralized Children’s Medicaid Centers (CMC) or designated regional
staff are responsible for:
 Processing Children’s Health Insurance applications and redeterminations for
designated regions and
 Processing client complaints for those actions.
For Children’s Health Insurance applications/redeterminations, the vendor sends a
‘Process a CMA Application’, ‘Process a CMA Redetermination’ or ‘Process a CHIP
Redetermination’ task, depending on the case action, to the appropriate CMC Region
queue based on the client’s residence zip code.
In addition, CMC staff will also receive Application Registration tasks from the vendor or
through the Self Service Portal for the programs they are responsible for processing.
Staff should follow the instructions outlined in IV. HHSC Eligibility Office – Application
Registration and Scheduling Tasks.
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ES State Processes
V.
December 2013
CUSTOMER CARE CENTER
Customer Care Center (CCC) is a virtual region located in six cities across the state.
They are located in Athens, Austin, El Paso, Houston, Midland and San Antonio. CCC
also includes a variety of centralized areas, including CCC Core, Central Processing
Center (CPC), Centralized Benefit Services (CBS) and Texas Women’s Health Program
(TWHP).
CCC Core staff is responsible for:
 Processing non-interview activities from end-to-end, including changes, alerts,
Process a System Denial, and missing information tasks;
 Processing certain Medicaid actions that do not require an interview;
 Evaluate Duplicate Application Tasks to confirm a complete action is or is not
needed & address changes when no complete action is needed
 Handle “Process a Combined Redetermination” tasks.
 Processing agency-generated changes;
 Processing client-reported changes;
 Processing CHIP Six Month income checks;
 Processing CHIP Enrollment Broker Exceptions; and
 Addressing client complaints.
Agency Generated Changes
CCC/MEPD (MEPD CCC/MEPD Region (#) Change) staff is responsible for working all
agency reported changes end-to-end. TIERS creates alerts for agency generated
changes. ‘Alert (#): (Alert Description)’ (i.e. ‘Alert 106: Intentional Program Violation
Disqualification Period Will End the Month’). Many of these alerts are converted
automatically to TLM tasks and processed by CCC or other responsible area. There are
still TIERS Alerts that staff are responsible for processing such as those related to
Second Level Reviews. Staff should continue to check their Welcome to TIERS home
page daily, and ensure the TIERS Alerts are processed appropriately.
Note: For agency generated changes mailed to the local Eligibility Office,
staff faxes the information to the vendor via the non-expedited fax line (1877-447-2839).
Date Of Death (DOD) Alert Processing
The Office of the Inspector General (OIG) receives reports from the Social Security
Administration (SSA) and the Bureau of Vital Statistic (BVS) of individuals who are
reported to be deceased. OIG systems match these reports to TIERS eligibility files to
determine if the individual is known to TIERS.
Once an individual is matched, the Deceased Individual Match information is sent to the
TIERS system. The TIERS system will receive and update the TIERS Individual Date Of
Death (DOD) information for all active and inactive individuals and will either:
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Or
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Deny single household member cases using the (Perfect) BVS DOD Data Match
information,
ES State Processes
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December 2013
Create and route an appropriate DOD Action Alert TLM task for ES staff case
action processing.
TLM Date of Death alert tasks automate the Form 1186 process for Deceased Individual
matches for OIG agency generated changes. ES staff does not need to complete the
form H1186 or send it in for case record imaging.
TIERS Mass Update Process Steps
When possible, the TIERS Mass Update (MU) process will complete the following
actions to a TIERS case:
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Populate the Date of Death within the Individual Data Collection page,
Set the verification source to “BVS record/death certificate”, and
If the case is active and in On-going mode, MU will run EDBC and take the
appropriate TIERS case action to reduce or deny benefits.
Or
• When the Mass Update process is unable to take the appropriate TIERS case
action, TIERS will trigger one of the following TLM Date Of Death Alert tasks
requesting staff to process the Date Of Death data match information within TIERS
for all active and inactive cases:
Alert 810 - Process a Date of Death with a
Perfect Match for Individual: X (where X is
the individual ID)
Alert 811 - Process a Date of Death with a
Non-Perfect Match for Individual: X (where
X is the individual ID)
Alert 812 - Verify discrepancy in Date of
Death for Individual: X (where X is the
individual ID)
Created when TIERS receives a record that
exactly matches a TIERS individual, and the
case is currently being worked (is in a mode
other than Ongoing), or the deceased is the
Head of Household.
Occurs when TIERS receives a death
record for an individual who seems to
match a TIERS individual, but doesn't
match exactly.
Occurs when TIERS receives a record that
exactly matches a TIERS individual, but the
Date of Death does not match the Date Of
Death already in TIERS.
ES staff Date Of Death (DOD) Data Match Process Steps
ES staff must review the task information take the appropriate TIERS case action to
pend, reduce, or deny benefits.
1. Claim and review the TLM DOD Data Match information and TIERS case,
2. Document the needed DOD action in TIERS Case Comments, and
2.1.
If the DOD TLM Alert source is BVS, then ES staff will:

Review and if needed update the TIERS DOD,

Review and if needed update the TIERS DOD Verification source,

Document DOD action in TIERS Case Comments, and
o
If the case is active, run EDBC to reduce or deny benefits,
accordingly.
o
If the case is inactive, no further action is needed by DI
staff.
Note: BVS Date Of Death (DOD) information received from BVS is an
acceptable source of valid verification.
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ES State Processes
December 2013
Or
2.2
If the DOD TLM Alert source is SSA, then ES staff will:

Pend the case using the Questionable HH Composition VCL to
issue form H1020 requesting verification of the current household
composition and residence location of the individual in question
(the deceased).

The notice sent to the decedent’s household will be sensitively
composed to verify the individual’s date of death. Staff will
document the following:
“We have received notice that there is a change in your
household composition. We have received a report that
(deceased name) may no longer be in your home. Please
provide verification of who is living in your home using the
enclosed Domicile letter and return this form to us by (Due
Date).”
 Ensure the form H1020-A Sources of Proof have both the
“Domicile/Household Composition” and “Death” blocks selected.
Note: SSA Date Of Death (DOD) information received from SSA is
not an acceptable source of valid verification.
3. Staff is expected to follow existing TLM processing and complete the Date Of Death
(DOD) MI TIERS case action and update the Individual page within Data Collection.
Enrollment Broker Expection Task
When HHSC staff disposes a CHIP/CHIP P EDG, an interface is sent to the Enrollment
Broker vendor. If there is an issue that results in an interface expection, an alert is
triggered and a TLM task is created and routed to CCC for processing. Clients will not
receive their benefits until these actions are resolved. Below are the two exceptions
tasks CCC staff will need to process:
Alert 748 - CHIP Enrollment Broker
Exception
Alert 817 - CHIP EB MU Exception
This alert is created whenever the
information sent by TIERS does not match
the Enrollment Broker system information.
This alert is created during a mass update
process and the Enrollment Broker system
does not match the TIERS information.
Changes Reported via OIG
OIG receives information from Social Security Administration (SSA) and Bureau of Vital
Statistics (BVS) Deceased Individual Matches; Texas Department of Criminal Justice
(TDCJ) and Prisoner Verification System (PVS) Incarceration Matches; Public
Assistance Reporting Information System (PARIS) Interstate Matches; and the Income
and Eligibility Verification System (IEVS) Data Matches. Information is also received
through the Hotline Call Center or the Waste, Abuse, and Fraud OIG website.
OIG creates an Action Notice in ASOIG for the IEVS and Interstate matches that require
action by ES staff. The ES Regional IEVS Match Coordinator logs into ASOIG to view
the Notice. OIG tasks Region CCC Form 1186 for the TDCJ and PVS match alerts.
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ES State Processes
December 2013
Failure to Return Review Packet (091 Denials)
Processing the denials of TANF, TANF-Level Medicaid or adult Medicaid households
when the ‘Alert 816: Review Packet Not Returned’ task is received for individuals who
fail to return their review packets and the case does not meet the auto-denial criteria.
System Denial Task
When a SNAP EDG is denied due to a missed appointment, and there are no pending
EDGs, but TIERS does not put the case in ongoing mode a ‘Process a Change for a
System Denial’ task is generated and assigned to the CCC for processing. CCC staff
will need to review the case EDGs and determine the appropriate action needed.
SNAP Terminated Task
When an individual’s SNAP EDG is terminated, and the same individual is also an
excluded member on a separate FS EDG/Case, an ‘Alert 732: SNAP Terminated
Determination for FS Necessary’ task is generated for the FS EDG/Case and
assigned to the CCC for processing. TW staff will need to make a FS determination
according to policy for the individual.
Duplicate Applications
When applicants submit multiple applications, the vendor determines if the applications
are either an identical copy or a duplicate application.
 If there is an identical application received, the vendor will link the identical
application to the case for all programs. No task is routed to the state.
 If there is a duplicate application received for Texas Works, the vendor
creates a ‘Duplicate (Program) Application’ change task and routes
appropriately to the CCC. Due date calculation for the TW change task will
follow change processing timeframes.
 If the duplicate application requests both MEPD and TW programs, the
vendor will create two tasks; one routed to the appropriate MEPD Region and
one routed to TW CCC.
 If the TIERS case has an active or pending TANF EDG, the vendor creates a
‘Duplicate Combined TW Application’ change task and routes the task to
the CCC TANF queue. Due date calculation for the TW change task will
follow change processing timeframes.
Client Reported Changes
CCC/MEPD (MEPD CCC/MEPD Region (#) Change) staff is responsible for working
most client reported changes. This section outlines the process.
1. If a client reports a change directly to the staff, the staff takes the change and
enters it into the State Portal - Report A TIERS Change portlet if it is received
without verification. If the change is received with verification, staff completes
an MI/Change Routing Cover Sheet and faxes it to the vendor (1-877-236-4123)
without entering the information in the State Portal Report A TIERS Change
portlet.
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ES State Processes
December 2013
2. If a client reports a change using the SSP, the information is passed to TIERS
for processing. TIERS will attempt to automatically update the case without
requiring worker action or create a ‘Change for a (Program) Case’ task. If
TIERS determines additional information is required, the case is automatically
pended and creates an ‘MI Requested on a SSP Change’ task and generates
a Form 1020 – Request for information or action.
SSP Exception Task
When a TIERS attempt to automatically dispose an SSP change fails, a ‘Process a SSP
Change Exception’ task is generated and assigned to the appropriate queue based on
program(s) for processing. Staff needs to review the case EDGs and determine the
appropriate action.
Changes Reported via OIG
OIG receives information from Social Security Administration (SSA) and Bureau of Vital
Statistics (BVS) Deceased Individual Matches; Texas Department of Criminal Justice
(TDCJ) and Prisoner Verification System (PVS) Incarceration Matches; Public
Assistance Reporting Information System (PARIS) Interstate Matches; and the Income
and Eligibility Verification System (IEVS) Data Matches. Information is also received
through the Hotline Call Center or the Waste, Abuse, and Fraud OIG website.
OIG creates an Action Notice in ASOIG for the IEVS and Interstate matches that require
action by ES staff. The ES Regional IEVS Match Coordinator logs into ASOIG to view
the Notice. OIG creates Form 1186 for the TDCJ and PVS matches and e-mails it to the
Regional Match Coordinator to take the appropriate action.
OIG sends Social Security Administration (SSA) and the Bureau of Vital Statistic (BVS)
Date of Death information for individuals who are reported to be deceased to TIERS.
The TIERS system will receive and update the TIERS Individual Date Of Death (DOD)
information for all active and inactive individuals and will either:

Deny single household member cases using the (Perfect) BVS Date Of Death
Data Match information,
Or
 Create and route an appropriate Date Of Death Action Alert TLM task for ES staff
case action processing.
Returned Undeliverable Mail
When the vendor staff receives undeliverable mail other than a Form H1830, it is imaged
and a task ‘Change for a (Program) Case’ is created and routed to the CCC/MEPD
(MEPD CCC/MEPD Region (#) Change) Global Queue for review and processing.
If a Form H1830 is returned as undeliverable, it is imaged and sent to the vendor as
returned mail. The vendor staff checks the status of the appointment to determine if
rescheduling is needed.
20
ES State Processes




21
December 2013
If the Appointment status is “No Show”, the vendor determines if the client
reported a change of address. (such as USPS Form 3547, call to 2-1-1 with case
comments in TIERS, updated address on application form in state portal).
If a change was reported and the address does not match in TIERS, the vendor
updates the mailing address in TIERS and attempts to contact the client by
phone to reschedule the appointment.
If the vendor is unable to make contact via phone, the appointment is
rescheduled and the Form H1830 is mailed to the correct address allowing at
least seven days for mail time.
If they determine that the address on the 1830 matches the reported change
information and no data entry corrections are needed, the vendor routes a task to
CCC/MEPD (MEPD CCC/MEPD Region (#) Change) TLM Global Queue for
appropriate action.
ES State Processes
December 2013
VI. TEXAS WOMEN’S HEALTH PROGRAM
Women’s Health Program (WHP) began as a Medicaid pilot program in 2007. Effective
November 1, 2012, WHP was replaced by the Texas Women’s Health Program.
Designated TWHP staff located in San Antonio is responsible for processing TWHP
applications and redeterminations. In addition, the TWHP staff process TP40
applications received by the vendor and changes for TIERS cases that contain only
active WHP or TP40 EDGs.
Texas Women’s Health Program (TWHP) - Applications
TWHP applications are received by mail or fax from the local office and they are also
received by the vendor who will route them via TLM – ‘Process WHP Application’.
Texas Women’s Health Program (TWHP) – Redeterminations
Women certified for TWHP may receive a Form H1867-R – Texas Women’s Health
Program Renewal Application or a Form H1831 - Adjunctive Eligibility Letter for
redetermination. Designated TWHP staff is responsible for processing ‘Process a WHP
Redetermination’ and ‘Process a WHP Adjunctive Redetermination’ tasks.
Pregnant Women Medicaid Applications
Upon receipt of an application for Pregnant Women Medicaid, the vendor creates a
‘Process a PW Application’ task and sends it to the WHP TLM Global Queue for
processing.
TWHP staff will also receive Application Registration tasks for TWHP and Pregnant
Women’s Medicaid from the vendor or through the Self Service Portal. Staff should
follow the instructions outlined in IV. HHSC Eligibility Office – Application
Registration and Scheduling Tasks.
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ES State Processes
December 2013
VII. CENTRALIZED BENEFIT SERVICES
The Centralized Benefit Services (CBS) staff is located in Austin and is part of the CCC
Region. The staff is responsible for processing SNAP-SSI cases for households in
which all members receive Supplemental Security Income (SSI). The staff also
processes Simplified Nutritional Assistance Program (SNAP-CAP), applications for
Medicaid Breast and Cervical Cancer (MBCC) Program, Medicaid for children under the
jurisdiction of the juvenile court and for youth under age 19 in non-secure facilities,
Refugee Medicaid Assistance and any associated FS case, and Foster Care Transitional
Medicaid. In addition, they process Request for Reviews for Reviews received on HCFFCHE and will assist with fair hearing requests received on some of their specialized
programs.
MTFCY Application/Redetermination Processing
Designated CBS staff will be responsible for processing FM H1011 applications and
redeterminations for the Medicaid for Transitioning Foster Care Youth Program from
end-to-end. They will receive ‘Process MTFCY Application’ and ‘Process a MTFCY
Redetermination’ tasks.
FFCC Application Processing
Designated CBS staff will be responsible for processing FFCC applications. They will
receive ‘Process an FFCC Application’ tasks.
MTFCY/FFCC Exception Task
In some instances, a TIERS case containing MTFCY or FFCC EDG will contain an
exception from interface files which must be cleared by CBS staff.
Below are the exception tasks that are generated for CBS:
Task Type
Program
MTFCY
MTFCY
Exception
Task Name
Alert 827: MTFCY Mass Update Exception
Alert 822: MTFCY Citizenship/Alien Status
Exception
Alert 820: FFCC Mass Update Exception
FFCC
Alert 821: FFCC Citizenship/Alien Status
Exception
FFCC
HC-FFCHE Redetermination Processing
HC-FFCHE redeterminations received by the vendor will be routed via TLM to CBS staff
responsible for processing the HC-FFCHE rederterminations from end-to-end. The staff
will receive either a 'Process a HC-FFCHE Redetermination' task for these actions.
23
ES State Processes
December 2013
HC-FFCHE Request for Review Task
Clients who disagree with a decision on their HC-FFCHE case must submit a written
request for a review of their case. Upon receipt of a request for review the vendor
creates a ‘Request for Review for a HC-FFCHE Case’ task and sends it to the CBSHC-FFCHE Global Queue. CBS staff must review the information provided and take the
appropriate action based on whether the client does or does not qualify for coverage.
SNAP – SSI Application/Redetermination Processing
Clients certified for SNAP -SSI may receive a Form H1840 – Recertification for SNAP –
SSI Benefits. The vendor will create a ‘Process a FS-SSI Redetermination’ for timely
redeterminations and a ‘Process a FS-SSI Application’ task if the packet is received
after the 15th day and on or before the last day of the last certification month. These
tasks will be routed to CBS staff responsible for processing the SNAP-SSI
redeterminations from end-to-end.
Note: Eligibility office staff is authorized to dispose SNAP-SSI applications
interviewed at the local office, including untimely SNAP-SSI
redeterminations.
SNAP - SSI Interviews
CBS staff will be responsible for scheduling and rescheduling face-to-face, telephone, or
home visit interviews for SNAP-SSI according to policy.
Simplified Nutritional Assistance Program (SNAP - CAP) Processing
HHSC outreach potential SNAP clients by mailing them a SNAP – CAP application,
Form H1841. CBS staff responsible for processing the SNAP – CAP applications from
end-to-end will receive a ‘Process a FS-SNAP Application’ task in the CBS-FS-SNAP
Global Queue. They will also receive a ‘Process a FS-SNAP Redetermination’ task
for renewal packets received timely.
Medicaid for Breast and Cervical Cancer Processing
A woman applies for MBCC through a BCCS provider who forwards the MBCC Form
H1034, Application for Medicaid for Breast and Cervical Cancer to a Department of State
Health Services (DSHS) contact. DSHS then faxes the application to the vendor creates
a ‘Process an Application Registration for TW’ or a ‘Process a MBCC Application’
task that is routed to CBS for processing.
In addition, when a Form H2340 – Medicaid for Breast and Cervical Cancer Renewal is
received, the vendor creates a ‘Process a MBCC Redetermination’ task that is routed
to the CBS-MBCC queue.
Individuals who received MBCC in another state and move to Texas will apply for MBCC
using form H2340-OS, Out of State Application for Medicaid for Breast and Cervical
Cancer. The vendor will create either ‘Process an Application Registration for TW’ or
‘Process a MBCC Out of State Application’ for these actions.
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ES State Processes
December 2013
In addition, CBS staff will also receive Application Registration tasks from the vendor for
the programs they are responsible for processing. Staff should follow the instructions
outlined in IV. HHSC Eligibility Office – Application Registration and Scheduling
Tasks.
RMA Processing
Publishing Office Capacity
RMA requires an interview; slots must be published using the Publish Office Capacity
function in the State Portal.
Supervisors are responsible for publishing the office capacity, and can refer to the State
Portal – Supervisor Support Tool for further instructions.
RMA must publish a sufficient amount of slots in the CBS-RMA queue to accommodate
application volume.
RMA Applications
Designated CBS staff is responsible for processing RMA applications from end-to-end.
A VolAg assists refugees in the application process and faxes form H1001, Application
for Benefit Assistance from the Voluntary Agency (VOLAG) Fax Coversheet, along with
form H1010, Texas Works Application for Assistance - Your Texas Benefits, to the
vendor for routing.
CBS staff will receive Application Registration tasks or Scheduling tasks from the vendor
for the programs they are responsible for processing. Staff should follow the instructions
outlined in IV. HHSC Eligibility Office – Application Registration and Scheduling
Tasks.
Note: RMA appointments must be scheduled as telephone interviews for
routing to the CMA-RMA queue. Face-to-face and home visit interviews will
be routed to a local office based on client zip code and must be
coordinated with local office staff.
Form H1001 & H1010 submitted
 Prior to or at the scheduled appointment time, the clerk must assign the ‘Check
In a Telephone Interview for a RMA Application’ or ‘Check In a Telephone
Interview for a Combined Application’, depending on the programs requested,
task to a designated worker from the CBS-RMA TLM Global Queue. This moves
the task to the worker’s TLM Personal Queue. The worker is then responsible for
determining if the client is a "Show" or a "No Show" and marks the task
accordingly.
 At the scheduled appointment time, the worker attempts to contact the client via
telephone. If contact is made, the worker conducts the interview, initiates TIERS
Data Collection, runs EDBC and sends MI if additional information is required, or
certifies/denies the case.
 If all necessary information is available, an eligibility determination is made. The
worker disposes the case in TIERS and sets the task in their TLM Personal
Queue to ‘Task Completed’. This clears the task out of the worker’s TLM
Personal Queue.
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ES State Processes
December 2013
VolAg Conservatorship Verification Task
In instances when an unaccompanied refugee minor turns age 18, the month following
the 18th birthday TIERS will trigger an alert which automatically creates an ‘Alert 802:
Verify VolAg Conservatorship’ task. CBS staff will need to take the appropriate action
based on whether the client is or is not under the conservatorship of a Volag.
TYC/TJPC Applications
CBS will mail form H1014, Application Information for Children's Health Insurance
Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, prior to the youths
release from a facility. Upon receipt of form H1014, CBS staff will be responsible for
performing Application Registration in TIERS, if required. Staff should follow the
instructions outlined in IV. HHSC Eligibility Office – Application Registration Tasks
This section outlines the process:
Form H1014 Submitted
Upon receipt of a Form H1014, CBS staff will perform Application Registration which
upon submittal creates a ‘Process a TYC/TJPC Application’ task and sends it to the
CBS Global Queue.
A designated CBS worker claims the ‘Process a TYC/TJPC Application’ task from the
CBS Global Queue. This moves the task to the worker’s TLM Personal Queue and the
task is no longer visible in the CBS Global Queue.
Medicaid for Inmates of a Public Institution Applications
Incarcerated children and pregnant women who are admitted to a hospital that is not
under the control of the Texas Department of Criminal Justice (TDCJ) for overnight
treatment of a medical condition are potentially eligible for Medicaid coverage during
their stay. TDCJ agent’s use the TDCJ fax coversheet and fax the coversheet and
application to the non-expedite fax line.
Upon receipt of a Form H1010 with the TDCJ Fax Coversheet, vendor staff will create a
‘Process a TYC/TJPC Application’ task and sends it to the CBS Global Queue.
Designated staff will be responsible for processing these Medicaid for Inmates of a
Public Institution applications submitted by TDCJ from end-to-end prior Medicaid.
CBS Disposition Tasks
In some instances, a TIERS case containing TW and/or MEPD EDGs will have a
specialized CBS EDG associated to it and it may require CBS staff to dispose those
benefits. Below are the tasks that are generated for CBS:
26
ES State Processes
Task Type
Disposition
Program
MTFCY
HC-FFCHE
FS-SSI
SNAP
MBCC
RMA
FFCC
December 2013
Task Name
Alert 801: MTFCY Has Not Been Disposed
Alert 760: HC-FFCHE Has Not Been Disposed
Alert 727: FS SSI Has Not Been Disposed
Alert 730: SNAP Has Not Been Disposed
Alert 791: MBCC Has Not Been Disposed
Alert 799: RMA Has Not Been Disposed
Alert 826: Has Not Been Disposed
Note: The disposition tasks must be disposed the same day of receipt in
order for the case to be moved to ongoing mode.
Client Reported Changes
SNAP - SSI Client Reported Changes
SNAP-SSI recipients can report changes to HHSC in person, by phone, mail, or fax.
Specialized CBS staff is responsible for processing the reported changes from end-toend. They will receive a ‘Change for a FS-SSI Case’ task in the CBS-FS-SSI TLM
Global Queue for clients report changes to the vendor.
SNAP – CAP Client Reported Changes
The vendor will route a ‘Change for a FS-SNAP Case’ task to the CBS-FS-SNAP TLM
Global Queue for SNAP – CAP client reported changes they receive.
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ES State Processes
December 2013
Agency Generated Changes
In some instances, CBS staff will receive Agency Generated Alerts for the programs they
process. Below is a list of tasks that will be routed to the appropriate CBS queue.
Task Type
Program
MTFCY
Task Name
Alert 762: MTFCY TPR
Information – nnnnnnnnn
Alert 800: MTFCY –
USCIS Alien
Documentation is Expired
Alert 761: HC-FFCHE
TPR Information –
nnnnnnnnn
Alert 763: Verification of
HC-FFCHE School
Enrollment’
HH-FFCHE
Agency
Generated
MBCC
SNAP - CAP
28
Action
Determine if adequate medical coverage
needs to be updated for MTFCY clients
TIERS automatically extends MTFCY
certification period if the USCIS alien
documentation is expired or will expire
during the first month of the new
certification period.
Determine if adequate medical coverage
needs to be updated for HC-FFCHE clients
TIERS automatically extends HC-FFCHE
certification periods and send a H1870,
School Enrollment Verificaiton form to
validate higher education information and
create a task. Staff will take appropriate
based on whether the form is received or
not.
Alert 803: HC-FFCHE –
USCIS Alien
Documentation is Expire
TIERS automatically extends HC-FFCHE
certification periods if she USCIS alien
documentation is expired or will expire
during the first month of the new
certification period and staff will need to
take appropriate action based on whether
the client’s alien documentation has or
hasn’t been renewed.
Alert 792: MBCC TPR
Information – nnnnnnnnn’
TIERS will generate an alert when TPR
data is received for an MBCC cas. CBS
staff will need to review these EDGs and
determine if adequate medical coverage
needs to be updated for MBCC clients.
Alert 731: Dormant
Advisor Action Necessary
In the event a SNAP – CAP EDG account
becomes dormant, TIERS will generate a
Form H1030, SNAP Lone Star Card
Assistance. If the client does not respond
to Form H1030 within 10 days, TIERS will
generate an alert that automatically creates
an ‘Alert 731: Dormant Advisor Action
Necessary’ TLM task is automatically
created and routed to the CBS-FS-SNAP
Global Queue. Staff will be responsible for
processing these tasks according to policy.
ES State Processes
December 2013
VIII. MEDICAID FOR THE ELDERLY AND PEOPLE WITH DISABILITIES
MEPD staff is located in the Customer Care Centers, throughout the state in Eligibility
Offices and outstationed facilities. MEPD staff located in the CCC assist the regions
with processing changes, alerts, and MEPD complaint tasks as well as take all escalated
MEPD Vendor calls. The San Antonio CCC has the sole responsibility of working all
IEVS that were generated since July 15, 2012. MEPD staff located in Eligibility Offices
are responsible for processing all MEPD applications/redeterminations and changes
(including MSP, MBI, Referral, and Facility application/redeterminations and changes),
and MEPD staff located in outstationed facilities are responsible for processing
applications/redeterminations and changes for clients in those facilities.
MEPD Applications
All MEPD applications received in the local offices will be mailed or faxed to the vendor
for imaging and task creation. A ‘Process a (Program) Application’ TLM task is
created and routed to the appropriate MEPD regional queue based on the client’s zip
code.
In addition, the vendor or Self Service Portal will create a ‘Process a MEPD
Application Registration’ task for the programs they are responsible for processing.
Staff should follow the instructions outlined in IV. HHSC Eligibility Office – Application
Registration and Scheduling Tasks.
MEPD Interview Requested
Face-to-face, telephone or home visit interviews are not required for MEPD. It is
however, good casework practices to contact the client or authorized representative on
every application. MEPD Management prefers this practice.
If a client requests an interview, the scheduling process will follow the TW processes.
Since interviews are not required, MEPD EDGs cannot be denied for failure to keep an
appointment.
MEPD Redeterminations
MEPD redeterminations follow the same processes as MEPD application processing.
Once the ‘Process a (Program) Redetermination’ TLM task is complete and the
redetermination disposed in TIERS, the worker sets the task in their TLM Personal
queue to ‘Task Completed’. This clears the task out of the worker’s TLM Personal
queue.
Note: When a MEPD worker discovers that a TLM task being worked
includes a request for MBI, the worker completes the task using a new task
completion option called ‘Transfer to MBI Queue’. By doing so, the
existing MEPD task is automatically routed to the MBI Global Queue, and is
re-named as a MBI task, with the Program and Location set as MBI.
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ES State Processes
December 2013
Reschedules
Requests for rescheduled appointment will be processed by the entity who receives the
request. For instance, clients who request a rescheduled appointment through 2-1-1 will
be rescheduled by the vendor staff. Clients who contact MEPD staff to have their
appointment rescheduled will be rescheduled by designated MEPD staff.
Note: Vendor staff can only process a reschedule if the original
appointment was scheduled through the State Portal Scheduler. If the
original appointment was not scheduled through the State Portal, they will
refer the client to the eligibility office for rescheduling.
LIS MSP Application Processing
The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requires
the Social Security Administration (SSA) (with the consent of those filing) to transmit LIS
(Low Income Subsidy) application data to the States. Once received, the LIS data would
serve as a protective filing for MSP (Medicare Savings Programs), with State agencies
being required to complete appropriate MSP development and make eligibility
determinations.
The LIS MSP applications are processed by a single unit located in El Paso. This unit is
tasked with processing all LIS MSP applications.
When a Form H1200EZ-MSP is returned for an individual known to TIERS or that is LTC
converted in TIERS, a ‘Process a LIS MSP TIERS Application’ task will be generated
in the LIS MSP Global Queue. In addition, if one is returned for an individual unknown to
the system, a ‘Process a LIS MSP Unknown Application’ task.
Medicaid Buy-In (MBI)
Applications with requests for MBI, as well as other MBI-related work, will be routed to
the statewide MBI TLM work queue. Staff will receive a ‘Process a MBI Application’ or
a ‘Process a MBI Redetermination’ task.
Note: When a case that has only a MBI EDG as the active MEPD program
and a change or a complaint is received for the case, then separate change
or complaint tasks shall be created and routed to the new MBI Global
Queue.
Medicaid Buy-In for Children Processing
When an application or redetermination for MBIC is received and imaged, a ‘Process a
MBIC Application’ or ‘Process a MBIC Redetermination’ task is created and routed
to the corresponding MBIC regional queue based on the applicant’s residence address
zip code.
Note: If a disability determination is requested, staff can
Select ‘Awaiting Disability Determination’ and the task
completion option which will update the task name and due
date.
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ES State Processes
December 2013
MEPD Referrals
A referral must be made with any request for eligibility for any of the DADS wavier or
Community Attendant (CA) services. Upon receipt of the Form H1746-A - MEPD
Referral Cover Sheet, the vendor will generate a ‘Process a MEPD Referral
Application (or Redetermination, or Change)’ TLM task for MEPD Referral
applications, redeterminations, and changes, which will be routed as appropriate.
Note: Until the messaging function of the DADS system is operational, the
MEPD worker will continue to notify DADS of the eligibility result using the
established DADS communication tool found at:
http://dadsview.dads.state.tx.us/me-to-dads/
The MEPD worker will only indicate if the client’s case has been certified or
denied and the denial reason.
Agency and Client Generated Change / Significant Change Processing
This section outlines the steps for processing MEPD client reported and agency
generated changes for waiver and Community Attendant (CA) cases. When a significant
change occurs, such as a denial of any of the functional eligibility components, or a
change in living arrangement, Adverse Action from Appeals, or Death of the client, the
DADS System (when operating) will communicate this change for TIERS to populate the
required pages. A ‘Change for a (Program) Case’ TLM task, including the appropriate
change type related to the TIERS data update being performed, is generated for the
worker to review eligibility, run EDBC, and dispose.
The distinction between different change types will be seen in a change type attribute
value associated with each task. This attribute is viewable when a specific task is
“expanded” to look at its details, and is also available as a search criterion in the
Advanced Filter. TLM will support the following new change types for TLM Change
tasks:
 Discharged from Facility
 Admitted to Facility
 LTSS Functional Assessment Update
 LTSS Monthly Cost of Care Change
 CC Waiver Denied
 CC Waiver Transfer
 Demographic Change
 ISP Update
 Income and/or Resource Update
Note: Upon receipt of Form H1263, Certification of Medical Necessity, the
vendor will generate and route a ‘Process a MEPD IME Change’ TLM task to
the appropriate MEPD regional queue for processing.
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ES State Processes
August 2013
MEPD Regional Change Processing
Each region will be responsible for processing client reported and agency generated
changes received in their MEPD Region (#) Change queue from end-to-end. They will
be responsible for processing the complaints routed to these queues as well as MEPD
dispositions tasks.
Note: CCC MEPD will be responsible for processing tasks that the system
is unable to route to a MEPD Region (#) Change queue.
Changes and Returned Mail
MEPD staff processing client reported changes, agency generated changes and
returned mail from the MEPD Region (#) Change queue should following instructions
outlined in Section V. Customer Care Center – Client Reported Changes, Agency
Generated Changes and Returned Undeliverable Mail sections.
Date Of Death (DOD) Alert Processing
MEPD staff processing DOD related alerts should follow Section V. Customer Care
Center – Date Of Death (DOD) Alert Processing section.
MEPD Disposition Tasks
In some instances, a TIERS case containing HC-FFCHE, FS-SSI and/or SNAP EDGs
will have an associated TW and/or MEPD EDG. Upon running EDBC, TIERS will
generate an alert that automatically creates an ‘Alert 729: MEPD EDG Has Not Been
Disposed’ TLM task when disposition is needed. This task will be sent to the MEPD
Region Change MEPD Regional staff will need to review these EDGs and determine
the appropriate action needed.
Note: The disposition tasks must be disposed the same day of receipt in
order for the case to be moved to ongoing mode.
Failure to Return Review Packet
MEPD Change Regions are responsible for processing the denials of MEPD households
when the ‘Alert 816: Review Packet Not Returned’ task is received for individuals who
fail to return their review packets and the case does not meet the auto-denial criteria.
Duplicate Applications
When applicants submit multiple applications, the vendor determines if the applications
are either an identical copy or a duplicate application.
 If there is an identical application received, the vendor will link the identical
application to the case for all programs. No task is routed to the state.
 If the duplicate application received is for MEPD, the vendor creates a
‘Duplicate MEPD Application’ change task and routes appropriately to the
MEPD Region queue. Due date calculation for the MEPD change task will
follow change processing timeframes.
 If the duplicate application requests both MEPD and TW programs, the
vendor will create two tasks; one routed to the appropriate MEPD Region and
one routed to CCC.
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ES State Processes
December 2013
Additional Processes
For more MEPD detailed processes, including the most recent version of the MEPD
Operating Procedures, please refer to the MEPD Website. Refer to the "Processes for
MEPD Virtual Staff" found in the appendices of the MEPD Operating Procedures for
specific information on processing forms related to transferred resources and
subrogation.
33
ES State Processes
IX.
December 2013
OUTSTATIONED/FACILITY WORKERS
HHSC currently contracts with over 300 health care providers (hospitals, clinics, nursing
homes, etc) for approximately 600 Outstationed Worker Program (OWP) positions.
These positions are filled by Texas Works and MEPD staff who determines eligibility for
all ES programs, with an emphasis on the medical programs. Staff in these outstationed
facilities is responsible for processing work from end-to-end and routing completed work
to the vendor as Image Only.
Texas Works and MEPD staff is responsible for performing inquiry and Application
Registration as needed. MEPD staff will use the State Portal to view images, access
TIERS and Datamart reports. Texas Work staff will also use the State Portal to view
images, access TIERS and Datamart reports and they will also use the State Portal
Scheduler and TLM for their scheduled appointments. Texas Works staff will also be
responsible for publishing appointment slots for their outstationed facility in the State
Portal Scheduler – Publish Office Capacity.
MEPD Processing
When an MEPD application is received, MEPD outstationed/facility staff will ensure the
appropriate MEPD task is created when performing Application Registration or manually
creating a process task using the State Create Task page.
Within 24 hours after the appropriate task is created, staff must route the
application/redetermination/supporting documents to the vendor as Image Only.
MEPD Facility Requests
The vendor will screen Forms H1200, H1200EZ, and H1200PFS to determine if the
applicant is requesting Facility services. A ‘Process a MEPD Facility Application (or
Redetermination)’ TLM task will include one of four designated MAO Types (State
School, Nursing Facility, ICF-MR, or State changes, alerts and MEPD complaint tasks
will be routed to the MEPD Region Facilities queue based on the client’s residence zip
code and program hierarchy. If the EDG is assigned to an individual other than the
TAAGeneric Worker, the system will automatically assign the task to that individual in
their personal queue. If the EDG is assigned to the TAAGeneric Worker, the task will be
routed as unassigned in the global queue.
Note: If MBI is included as a program, the task is routed to the MBI Queue.
If MBI is not present but MBIC is included as a program, the task is routed
to the MBIC Regional Queue.
Texas Works Processing
When a Texas Works application is received, Texas Works outstationed will ensure the
appropriate Texas Works task is created when performing Application Registration,
manually creating a process task using the State Create Task page or scheduling an
appointment. They will also ensure it is assigned to the appropriate outstationed
location.
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ES State Processes
December 2013
NOTE: Staff can only schedule appointments to a specific outstationed
facility if they have a portal role for that outstationed facility.
Once the eligibility decision is made, the completed paper forms are routed to the vendor
as Image Only.
35
ES State Processes
December 2013
X. CENTRAL PROCESSING CENTER
The Central Processing Center (CPC) is comprised of ES staff located in Austin and are
part of the CCC Region. These staff is responsible for processing all children's Medicaid
referrals and steam lined Forms H3038P CHIP Perinatal Emergency Medical Services
Certification.
CHIP Perinatal Form H3038P Process
CHIP Perinatal clients whose income is below 185% of the Federal Poverty Income Limit
(FPIL) are not required to complete an application to apply for Emergency Medicaid for
the birth of their child. Instead, a Form H3038P is generated by TIERS and mailed to
the client to complete and return. All Forms H3038P are routed to CPC for processing.
Once a Form H3038P is received by the vendor, a ‘Process a Form 3038P’ or a
'Process an Application Registration for Form 3038P' task will be systematically
created and routed to the CPC TLM global queue.
If the Form H3038P is received in the local eligibility office, staff should follow the
instructions in the Document Routing Procedures - Support Tool and fax to the
vendor.
Note: When a Form H3038P is returned sixty (60) days after the child’s due
date listed in TIERS, inform the client they must reapply for benefite.
36
ES State Processes
December 2013
XI. CENTRALIZED REPRESENTATION UNIT
The ES-Centralized Representation Unit (ES-CRU) staff represents the agency in ES
Texas Works and MEPD fair hearings.
Note: CBS is responsible for processing MTFCY and RMA fair hearing
requests and FFCHE Requests for Review.
Fair Hearings Processing
Individuals may request a fair hearing in person, in writing, or over the phone to appeal a
case action or to dispute policy. All TIERS fair hearing requests will be entered in to the
State Portal and routed to the ES-Centralized Representation Unit (ES-CRU) for
processing.
Initial Fair Hearing Request
The ES-CRU will receive a ‘Appeal Request for (program/TOA)’ and review the case,
perform case corrections if appropriate and will create a fair hearing request in TIERS
that is sent to the Hearing Division.
Scheduled Fair Hearing Request
Once the fair hearings request has been scheduled by the Hearings Division staff, a
‘Fair Hearing Appointment for a (Program) Case’ task will be routed to the Fair
Hearings Centralized Unit TLM Global Queue.
Note: A “Star” icon will appear on the task if the Fair Hearings Officer
assignment changes.
Fair Hearing Decision
Once the fair hearing has been held and a decision has been rendered, the hearings
officer records the decision in TIERS and a TLM task is created and routed to the Fair
Hearings Centralized Unit TLM Global Queue for processing.
 If the decision is reversed, a ‘Process Fair Hearings Reversal Decision for
(Program/TOA)’ TLM task is created and routed to Fair Hearings Centralized
Unit TLM Global queue.
 If the decision is sustained and the conditions below are met, a ‘Fair Hearings
Sustain Decision for (Program/TOA)’ task will be created and routed to the
Fair Hearings Centralized Unit TLM Global Queue and for processing.


37
Conditions include:
A decision is made that does not “reverse” the previous agency determination,
the case is eligible for continued benefits and the client has not waived the right
to continued benefits.
A ‘ Fair Hearings Decision Issued for (Program/TOA)’ task will be created for
decisions issued that do not typically require an agency action.
ES State Processes
December 2013
XII. CHIP REQUEST FOR REVIEW (RFR)
The CHIP Request for Review Unit represents HHSC in CHIP and CHIP Perinatal
Request for Reviews.
Request for Review Processing
A request for review is any expression of dissatisfaction with an adverse action for a
CHIP or CHIP Perinatal case. Households have thirty (30) business days from the date
the notification letter was sent to the household. The request for review must be
submitted in writing.
The following task is created by the vendor and routed to the Fair Hearings global
queue:
 ‘Initiate Request for Review’
Once the CHIP RFR staff claim and mark the above task as ‘Complete’, one of the
tasks below will be created and assigned to them in their personal TLM queue.


‘Process a Request for Review for a CHIP Case for EDG: XXX’
‘Process a Request for Review for a CHIP-P Case for EDG: XXX’
RFR Questions
If state staff has questions or concerns about an RFR, they can contact the RFR staff
listed below:
CHIP RFR Questions:
 Merlin Crow: merlin.crow@hhsc.state.tx.us,
 Dayo Aliu: dayo.aliu@hhsc.state.tx.us.
CHIP-P RFR Questions:
 Yvette Mathews: Yvette.matthews@hhsc.state.tx.us
If a client has a question about their RFR, they can contact 2-1-1 or their local office.
Request for Continued Enrollment Processing
If the child's physician or health plan determines that a suspension or termination of
enrollment could seriously jeopardize the child's life or health, the household can request
Continued Enrollment.
The following task is created and routed to the Fair Hearings global queue:
 ‘Initiate Request for Review with CE’
Once the CHIP RFR staff claim and mark the above task as ‘Complete’, one of the
tasks below will be created and assigned to them in their personal TLM queue.
38
ES State Processes



December 2013
‘Process a Request for Review with CE for a CHIP Case for EDG: XXX’
‘Process a Retro Request for a CHIP Case for EDG: XXX’
‘Process a Retro Request for a CHIP-P Case for EDG: XXX’
The following tasks are used to communicate between Medicaid CHIP Division (MCD)
and CHIP RFR when a Health Plan Retro Coverage Request or CHIP Enrollment Fee
Extension Request comes directly to HHSC.
When the CHIP RFR needs to inform MCD that a Health Plan Retro Coverage Request
or CHIP Enrollment Fee Extension Request has been requested they will send the
following manual task to MCD Any detail information MCD needs to complete their task
will be entered in the comments.


‘Process a CHIP/CHIP-P Health Plan Retro Coverage Request’
‘Process a CHIP Enrollment Fee Extension Request’
When MCD has completed their step for either the Health Plan Retro Coverage
Request or CHIP Enrollment Fee Extension Request they will send the following manual
response task back to CHIP RFR. Any detail information HHSC needs to complete their
task will be entered in the comments.


39
‘Process a CHIP/CHIP-P Health Plan Retro Coverage Response’
‘Process a CHIP Enrollment Fee Extension Response’
ES State Processes
December 2013
XIII. DATA INTEGRITY
Data Integrity is responsible for processing manual certifications for ME-SSI and
processing certain changes on those benefits. They add Medicare Cost Share for SSI
client’s only, clear rejections from interface files, and process Managed Care corrections.
In addition, they are responsible for processing Medicaid for newborns, Merge/Separate
actions, as well as processing demographic changes on individuals who have been file
cleared and certified.
Change for a MEPD-SSI Case TLM task
When a change for an ME-SSI EDG is reported, the vendor creates a ‘Change for a
MEPD-SSI Case’ TLM task. The change task will have one completion option: ‘Task
Completed’, with a due date of one business day.
Upon receipt of a change for a ME-SSI EDG, the vendor creates a ‘Change for a
MEPD-SSI Case’ task and sends it to the DI Global Queue for processing.
Freeze Flag Alerts
Since SSI cases are the responsibility of DI, they will be given the option to set an
indicator called ‘Freeze SDX Update’ on the EDG address in TIERS that will prevent the
SDX interface from updating the EDG address. DI will be the only group with access to
set and release the ‘freeze’ indicator.
Note: The ‘freeze’ indicator when set, will not limit other authorized users’
ability to update EDG addresses.
When the SDX interface attempts to update the address of an EDG with the ‘freeze’
indicator set, TIERS will not allow the transaction. In addition, the TLM task, ‘Alert 764:
SDX Address Update Not Processed Due to Freeze’, will be created and sent to DI
for processing. The task will require DI to review the SDX update and determine if the
Social Security Administration (SSA) requires notification of the change.
ME SSI Manual Certifications
DI ME SSI Eligibility staff is responsible for ME SSI Medicaid and ME SSI Facility
Medicaid certifications, disposals, and denials. They also make corrections to
addresses and county codes for eligible SSI recipients statewide. Staff can send these
ME SSI requests to the following mailbox: HHSC CCC Data Integrity Program
@hhsc.state.tx.us
All emails sent to the HHSC TIERS Disposition Request mailbox should include the
following information:



40
Client name
Case number
Nursing facility name
ES State Processes


December 2013
Date client entered/discharged from the nursing facility (if appropriate)
Brief description of the action that is needed
Medicare Buy In
Data Integrity Buy In staff adds Medicare Cost Share for SSI clients only and clear
rejections from interface files. If field staff receives inquiries/complaints in the local office
for client’s whose Medicare Cost Share has been certified for 120 days or more and their
Medicare premium continues to be deducted or SSI client who have Medicare Part A
and their QMB coverage has not been established, emails should be sent to HHSC CCC
Data Integrity Program @hhsc.state.tx.us.
All emails sent to the HHSC DI_Buy In mailbox should include the following information:
 Client name
 Case number
 Brief description of the action that is needed
QI-1
Data Integrity QI-1 staff process a monthly billing voucher for the HHSC accountants to
charge or reimburse for monthly premiums paid for coverage that has started or ended.
The DI staff is informed of the coverage that is granted or terminated via the Form 3081.
MEPD field staff is responsible for sending a completed Form 3081 to Data Integrity by
mail, fax, or email to the following mailbox: HHSC CCC Data Integrity Program
@hhsc.state.tx.us.
Managed Care
DI Managed Care staff is responsible for reviewing and correcting discrepancies in
Managed Care coverage. These requests are received from the Managed Care
Operations Enrollment Broker Managed Care Specialists. Requests are sent to the
following mailbox: HHSC CCC Data Integrity Program @hhsc.state.tx.us
Newborn Eligibility
Data Integrity Newborn Eligibility staff are responsible for researching and correcting
discrepancies in Medicaid eligibility for newborns whose mother is Medicaid eligible.
They also clear exceptions from interface files and process referrals received from
hospitals. The hospitals are responsible for sending these requests to Data Integrity by
mail, fax, or email to the following mailbox: HHSC CCC Data Integrity Program
@hhsc.state.tx.us.
Merge & Separate
All merge or separate requests need to be requested in TIERS via the Data Integrity
functional area on the Left Nav. When merge or separate requests are made in TIERS,
the corresponding TLM tasks are created for Data Integrity (DI) staff. DI merges client
individual numbers only. Case numbers cannot be merged. If it is determined that
additional case actions are needed by eligibility staff, prior to processing the merge or
41
ES State Processes
December 2013
separate action, DI will complete the merge or separate task with the appropriate
completion option which will result in the following tasks:



If further case actions are needed to process the merge or separate the system
will create a ‘Perform Requestor Pre-merge/separate Casework’ task and
assigns the task to the individual who made the initial merge or separate request.
If the system is not able to assign a TLM task to the individual who requested the
merge or separate, a task will be routed to the requestor’s primary TLM location.
If further case action is needed by field staff other than the initial requestor the
system will create a ‘Perform Field Staff Pre-merge/separate Casework’ task
and assigns the task to the global queue of the office who serves the case
residential zip code.
If the merge or separate action results in a change in benefits the system will
create a ‘Perform Disposition Casework for a Merge/Separate’ task and
assigns the task to the individual who made the initial merge or separate request.
If the system is not able to assign a TLM task to the individual who requested the
merge or separate, a task will be routed to the requestor’s primary TLM location.
Note: The disposition tasks must be disposed the same day of receipt in
order for the merge or separate process to resume.


If a merge or separate request is determined invalid the system will create a
‘Merge/Separate Request Not Successful’ task and assigns the task to the
individual who made the initial merge or separate request. If the system is not
able to assign a TLM task to the individual who requested the merge or separate,
a task will be routed to the requestor’s primary TLM location.
Once the merge or separate process is determined successful the system will
create a ‘Merge/Separate Request Successfully Completed’ task and assigns
the task to the individual who made the initial merge or separate request. If the
system is not able to assign a TLM task to the individual who requested the
merge or separate, a task will be routed to the requestor’s primary TLM location.
Note:
 All case work must be completed prior to requesting the merge.
 All cases need to be denied or in Ongoing Mode prior to requesting
the merge.
 Staff should review the “Preventing and Resolving Multiple ID
Numbers in TIERS Cases” job aid for client individual numbers on
multiple active cases.
Staff follows the steps below:
 The worker reviews the task comment to determine what case action is needed.
 The worker completes case processing in TIERS and disposes the case, if
necessary.
 The worker marks the TLM task to ‘Task Completed’. This clears the task out of
the worker’s Personal Queue and releases the ‘on hold’ status of the ‘Process a
Merge/Separate Request’ task if applicable.
42
ES State Processes
December 2013
Biographical Corrections
All Texas Works and MEPD staff have the ability to correct name, phone numbers, and
address information in TIERS. Data Integrity Bio Corrections staff process gender, SSN,
SSCN, and DOB corrections. If file clearance has occurred and the individual certified,
staff can send requests to DI at the following mailbox: HHSC CCC Data Integrity
Program @hhsc.state.tx.us.
All emails sent to the HHSC DI Biographical Corrections mailbox should include the
following information:




43
Client name
Client number
Case number
Brief description of the action that is needed
ES State Processes
December 2013
XIV. ES CBO REGIONAL OFFICE
ES CBO Regional Office is comprised of eligibility staff located in Region 8 and they are
responsible for processing applications/redeterminations from one of five food banks
within Texas that are authorized to conduct interviews on behalf of HHSC. These five
food banks are a part of the Community Partner Interviewer pilot (CPI).
These CPIs have the ability to submit applications and redeterminations via the
Community Partner (CP) Self Service Portal (SSP), e-mail, paper or fax and they will
designate the CBO Mode as ‘Assisted’ or ‘Interviewed’. The CPI Interviewer is
responsible for identifying the CBO Mode on the CBO Non-Interviewed, Non-Expedited
Application Cover Sheet or within the SSP.
‘Interviewed’ applications means the CPI Interviewer conducted a SNAP program
interview on behalf of HHSC, and either obtained or informed the applicant of the
required program verifications necessary for HHSC to determine eligibility. The CPI
Interviewer can only conduct interviews for the SNAP program.
‘Assisted’ Applications/Redetermination Processing
‘Assisted’ applications means the CBO helped the applicant with completing the
application, accessing the SSP, gather supporting documents, and informed the
applicant of the general information HHSC will need to determine benefit eligibility using
HHSC Form H1858.
If an ‘Assisted’ application or redetermination is received from the CBO by FAX or mail,
the designated Region 8 staff will process the action by either scheduling an
appointment or manually creating a ‘Process a [Program] Application’ or ‘Process a
[Program] Redetermination’.
If an ‘Assisted’ application is received from the CPI via the CP SSP, TLM automatically
creates a ‘Process a SSP Application Registration‘ or ‘Process an Expedited SSP
Application Registration’ task and routes to the local ES office based on the
applicant’s zip code. Staff will follow current SSP procedures to process the application.
‘Interviewed’ Application/Redetermination Processing
If an ‘Interviewed’ application or redetermination is received from the Region 8 staff by
FAX or mail, designated staff will review the application to determine if the client has
requested other programs besides FS that requires an interview.
If an additional interview is not required on the faxed or mailed document, the staff will:
1. Perform Application Registration and enter the CBO information is entered
correctly and answer the CBO question appropriately if needed.
2. If Application Registration performed, TLM will automatically create a
‘Process a [FS or Combined TW] CBO Interviewed Application’ tasks.
If Application Registration is not needed, staff manually create a
‘Process a CBO Interviewed Application for [FS or Combined TW]’ or
‘Process a CBO Interviewed Redetermination’ for [FS or Combined TW]’
task.
44
ES State Processes
December 2013
3. The worker claims the task and processes the application appropriately.
If an additional interview is required on the faxed or mailed document, the staff will
1. Perform Application Registration and enter the CBO information is entered
correctly and answer the CBO question appropriately if needed.
2. Schedule the appointment in the State Portal Scheduler to create a ‘Check in
a [Face-To-Face or Home Visit or Telephone] Interview for a CBO
Interviewed Combined TW Application’ or ‘Check in a [Face-To-Face or
Home Visit or Telephone] Interview for a CBO Interviewed Combined
TW Redetermination’ task.
3. The worker claims the task and processes the application appropriately.
If an ‘Interviewed’ application is received from the CBO via the CP SSP, TLM
automatically creates and routes a
 ‘Process a CBO SSP Interviewed Application Registration for [’TW’ or
‘Combined TW-MEPD’]’ or
 ‘Process an Expedited CBO SSP Interviewed Application Registration for
[’TW’ or ‘Combined TW-MEPD’]’
The designated staff reviews the application to determine if the client has requested
other programs besides FS that requires an interview.
If an additional interview is not required, the staff will
1. Complete Application Registration and ensure the CBO information is correct
and answer the CBO question appropriately.
2. Once App Reg is complete, TLM will automatically create a ‘Process a [FS
or Combined TW] CBO SSP Interviewed Application’ task.
3. The worker claims the task and processes the application appropriately.
If an additional interview is required, the staff will
1. Perform Application Registration and ensure the CBO information is correct
and answer the CBO question appropriately.
2. Schedule the appointment in the State Portal Scheduler to create a ‘Check In
a [phone, face, home] Interview for a CBO Interviewed ’Combined TW’
Application’.
3. The worker claims the task and processes the application appropriately.
Note: Staff performing Application Registration must ensure that the CBO
related information is entered correctly within Application Registration. In
addition, staff processing CBO related actions must ensure all CBO related
information is correctly entered within the TIERS CBO Logical Unit of Work.
If an ‘Interviewed’ SNAP redetermination, which does not include TANF or Adult
Medicaid, is received from the CBO via the CP SSP, TLM automatically creates and
routes the following:
‘Process a CBO SSP Interviewed Redetermination for [’FS’ or ‘Combined
TW’]’
If an ‘Interviewed’ SNAP redetermination is received from the CBO via the CP SSP,
and another interview is needed for TANF or Adult MA, TLM automatically creates and
routes the following:
45
ES State Processes
December 2013
‘Schedule a Redetermination Appointment Task for [’FS’ or ‘Combined
TW’]’
Reschedules
In instances where applicants request a rescheduled appointment by contacting the local
office or through 2-1-1, the caller will be re-directed to the designated ES CBO Regional
contact person to reschedule the ES CBO Regional appointment.
Note: Only authorized ES CBO Regional staff may reschedule CBO
appointments.
CBO Documents Submission
The CBO routes paper applications, supporting documents and Missing Information (MI)
directly to their assigned HHSC CBO Regional Office via Encrypted Voltage e-mail, fax
or hand-delivery. If a document is routed to the vendor, it follows normal business flows
and is not identified as a CBO document. All documents received by DPC will follow
existing processes.
CPs can also upload support documents via SSP during the application and
redetermination submission process or later when a case number exists for the SSP
application.
ES CBO Contacts
Region Contact Name
Karen Gordon – TW Supervisor
Melissa Torres – Program Manager
Dee Ann Smith – Lead Program Manager
Grace Moser – Regional Director
8
46
Phone Number
Community Partner
(210) 646–3516
(210) 619-2946
(210) 619–8260
(210) 619–8019
North Texas Food Bank
(NTFB)
San Antonio Food Bank
(SAFB),
South Plains Food Bank
(SPFB),
Tarrant Area Food Bank
(TAFB),
Houston Food Bank
(HFBO)
ES State Processes
December 2013
XV. GENERAL PROCESSING
This section provides information that is used by Eligibility Office, ART, CCC and MEPD
staff.
Duplicate Applications
In the event an application is received by the vendor and it is identified as a ‘Duplicate’
as outlined by policy, a task is created and routed to the appropriate CCC or MEPD
Region (#) queue for processing as outlined in V. Customer Care Center – Duplicate
Applications.
If a ‘Duplicate’ application is received in an eligibility office or outstationed facility, staff
should follow the steps below:
1. Designated staff will access the State Create Task page and manually
create a ‘Duplicate (Program) Application’ task and select the appropriate
location they have access to from the Routing Location drop down menu.
2. Once the task is created for the appropriate eligibility office or outstationed
facility, the worker will claim the task and process the duplicate
application/redetermination appropriately.
3. Once the action is complete, the document will be routed to the vendor
following the Image Only document process.
Identical Applications
If an application is received by the vendor and it is determined to be an ‘Identical’
application as defined by policy, the vendor will classify the document as an ‘Identical’
application and link it to the appropriate TIERS case. In addition, comments will be
automatically added to TIERS Case Comments and a task will not be routed to the state.
If an application is received by the eligibility office or outstationed facility and it is
identified as an ‘Identical’ application as defined by policy, staff must write ‘Identical
Application’ on the front page and route to the vendor following the Image Only
document process.
Client Reported Changes
CCC and MEPD (CCCMEPD/MEPD Region (#) Change) staff are responsible for
working most client reported changes from end-to-end. If a client reports a change
directly to the staff
 without verification, the staff takes the change and enters it into the State PortalReport A TIERS Change portlet and the system will automatically create and
route the change task appropriately.
 with verification, staff must complete a MI/Change Routing cover sheet and then
fax it to the vendor at 1-877-236-4123. The system will create and route the
change tasks appropriately.
Note: Others may be responsible for processing a change if they are
processing an application or redetermination action.
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ES State Processes
December 2013
Client Inquiries
Clients may dial 2-1-1 for case status inquiries. Follow the same process regardless of
the point of entry. Make an initial good faith effort to respond to the client no matter the
point of entry.
Vendor action for phoned, faxed or mailed inquiries:
 Check inquiry in TIERS.
 Check schedules through State Portal Scheduler search.
 Respond to the individual if the initial inquiry can be resolved.
 If the initial inquiry cannot be resolved, it may be routed to the centralized
Special Escalation Unit (SEU) for the vendor to assist.
 The SEU staff views all the logs, all inquiry systems, case data entered, or
comments documented.
 The SEU worker makes every possible attempt to respond to the inquiry.
 If the inquiry cannot be resolved, escalate it to the designated state
escalation queue to provide assistance or use the escalate flag within TLM
which flags the open TLM task.
Eligibility Office (TIERS) staff action for walk in clients.
 Check inquiry in TIERS.
 Check schedules through State Portal Scheduler search.
Complaints
Complaints can be received from clients and Authorized Representatives via phone, fax
or in person. These complaints can be received by vendor or Eligibility Office staff at
any time.
Complaints Received by ES Staff
Complaints received at the Eligibility Offices are reviewed to determine if the complaint is
for the receiving office. If the complaint is for the receiving office or another Eligibility
Office, staff follows established procedures to resolve the complaint locally. These
complaints are not routed to the vendor for resolution.
If the complaint received is regarding the vendor and/or its staff, the Eligibility Office staff
logs the complaint through the State Portal, using the Complaints Tab portlet. This
complaint information will be routed to the vendor’s escalation unit for
investigation/resolution.
Complaints Received by Vendor
Complaints received by the vendor will be entered into the State Portal Complaints
portlet and they will attempt to resolve them. Complaints they are not able to resolve
and therefore require escalation to the state, will be routed to the appropriate location
through TLM. Vendor staff will manually create one of the following two TLM tasks
below.
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A ‘Complaint for a TW Case’ TLM task for TW complaints will be routed to the following
locations:
 Office (eligibility office based on client’s zip code)
 CCC
 ART WHP
 CBS-MTFCY
 Fair Hearings (TW and MEPD)
 FFCC
 CBS-FS-SSI
 CBS-FS-SNAP
 CBS-HC-FFCHE
 CMC
 CPC
 CBS-MBCC
 CBO
 CBS-RMA
A ‘Complaint for a MEPD Case’ TLM task for MEPD complaints will to be routed to the
CCC MEPD or the MEPD Region (#) Change TLM Global queue.
Note:
 If MBI is included as a program, task will route to MBI Queue based
on case zip code
 If MBIC is included as a program and MBI is not, task will route to
MBIC Regional Queue based on case zip code
Staff should follow their regional or local office procedures when processing and
resolving complaints. Once the complaint is resolved, staff should mark the TLM task as
‘Complete’.
Missing Information - No Anchor Task
When clients submit missing information or postponed verification to the Eligibility Office,
clerical staff date stamp and perform inquiry to determine if ownership of the MI is for a
worker in that office or if there is an outstanding task associated to that case still in any
other locations TLM Queue.
If it is determined that the MI belongs to that office, the information is routed to the
appropriate worker. Once the case is completed, the MI is sent in for Image Only.
If it is determined there is no associated task for the information received, or if it is
determined that the MI belongs to another office, it is faxed to the vendor at
1-877-236-4123. The vendor reviews all information received and documents the
receipt of the information in TIERS Case Comments.
Once the vendor classifies the information as Missing Information, the system will flag all
open TLM tasks with an MI flag. If there are not any open TLM tasks, the system will
determine if there are any active, pending, suspended or denied TIERS EDGs and
determine the appropriate TLM task assignment and routing. Staff will need to review
the information to determine the appropriate case action.
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If all TIERS EDGs are currently active, the system creates a ‘Change for a
(Program) Case’ task to the CCC TLM Global Queue for processing.
If there is a pending TIERS EDG(s), the system will create a ‘Missing
Information for a (Program) Case’ task and assign and route the task to the
individual who pended the EDG(s). If the system is not able to assign a TLM
task to the individual who pended the EDG(s), a task will be routed to CCC or
to the MEPD Regional queue as unassigned.
If there is an EDG(s) that has been denied for failure to provide, the system
will create a ‘Missing Information for a (Program) Case’ if the denial
occurred within re-open policy timeframes. The system will automatically
assign and route the task to the individual who denied the EDG(s) for failure
to provide. If the system is not able to assign the TLM task to the individual
who denied the EDG(s), the task will be routed to CCC or to the MEPD
Regional queue as unassigned. Staff will be responsible for determining the
appropriate action needed, if any, based on policy guidelines. This section
outlines the process.
Fair Hearings Requests
Individuals may request a fair hearing in person, over the telephone, or in writing.
If the request for a fair hearing is received in person or via telephone by state staff, the
person who receives the request must:
 Contact the supervisor or worker in charge to speak with the client or
Authorized Representative.
 Explain the action taken and the reason for the decision and,
 Inform the client of his/her rights.
If the client still chooses to continue the fair hearing process:
 The worker/supervisor enters the fair hearing request in the State Portal
Appeals tab in the Add New Appeal portlet. These entries will automatically
create an ‘Appeal Request for (Program/TOA)’ for the ES-Centralized
Representation Unit (ES-CRU) staff.
 The information entered into this section will be used by the ES-CRU for
processing the request and completing the Form H4800 - Fair Hearing
Request Summary.
If HHSC staff receives fair hearing requests via fax or mail, staff follows established
office processes for reviewing the action being appealed. If the client still chooses to
appeal:
 The worker/supervisor faxes the appeal using the fair hearing cover sheet via
the expedited fax line (1-866-559-9628) for processing. DO NOT complete
and submit a Form H4800 or enter the fair hearing request in the State Portal.
 This information is used by specialized staff to process the fair hearing
packet.
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Handling of Inappropriate Documents
An inappropriate document is information provided by a client that is not related to a
case and is deemed inappropriate in nature; such as threats, pornography etc.
Documents may be received by mail, in person, or a client may upload a document via
www.yourtexasbenefits.com .
If an inappropriate document is linked electronically to a case, whether by vendor staff or
via client upload, staff must send an email to
OES_Vendor_OPS_Oversight@hhsc.state.tx.us and request the delinking of the
information from the case. Staff should include a detailed description of the issue in the
body of the e-mail and include the information below:
 Case Number
 MAXeIE App ID or DCN if it is related to an Application Registration task
Staff should notify their supervisor and worker III, who in turn should report the incident
to the Regional Director, regional officer and their Regional Administrative Services
(RAS) representative.
Additionally, any document regarding threats to HHS regional staff should mirror the
enterprise Safety and Security for Regional/Local Offices policy number SSS/RAS-002
which can be found at:
http://hhscx.hhsc.state.tx.us/Admin/ras/ServiceGuideForms/Safety%20_Security_v1_7.p
df
Disaster SNAP Processing
In the event a major disaster is declared, clients not currently receiving SNAP can apply
for assistance by submitting a Disaster SNAP Application to an Eligibility Office or
application intake site in the impacted area or at identified satellite locations that are
serving persons affected by the disaster.


Eligibility Office – When a Disaster SNAP Application is received from the client
at an Eligibility Office, staff accepts the application, conducts the interview,
processes the request, and sends the application for imaging. Eligibility Office
staff will receive detailed location(s) information from ES Management staff once
the disaster is declared.
Intake Site – When a Disaster SNAP Application is received from the client at an
intake site, intake site staff conducts the interview, and ship the application to the
DPC for imaging. Once imaged, a “Process a Disaster Application” task will
be created automatically and routed to the Disaster Global queue for processing
in TIERS by designated staff. If an eligibility office is overwhelmed by the volume
of Disaster SNAP applicants, it may change the process to function as an intake
site.
SSP Account Management
Clients must set up an SSP Case Visibility account in order to view case information and
report changes by going through advanced authentication. If a client loses their SSP
password or is unable to set up a case visibility account because they cannot correctly
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respond to the authentication security questions via the SSP, they may request
assistance from HHSC or the vendor.
Reason
Alternate Account Set
Up/Password Reset
If the client is…
In the office…
Contacting the office by
phone…
Action
Then, verify the client’s
identity and use the State
Portal SSP Account
Management tab to grant
case visibility access or
password reset.
Then, refer the client to 2-11 for assistance.
Escalating Vendor Processing Issues
In the event staff identifies issues related to vendor processing, they should escalate
them to their supervisor or person acting in a supervisory capacity. Supervisory staff will
be responsible for reviewing the issue to determine if further escalation is needed. If
escalation is needed, supervisory staff should route the issue to the ES Vendor
Operations staff at the e-mail address below:
Mailbox Display Name: HHSC OES Vendor Operations Oversight
E-mail address: OES_Vendor_Ops_Oversight@hhsc.state.tx.us
The subject line should include the following information:
 Action Needed or Informational
 Identify error: Scheduling, Rescheduling, Imaging, etc.
 Region
Example: Action Needed: Reschedule-Reg 7
Staff should include a detailed description of the issue in the body of the e-mail and
include the information below.


Case Number
MAXeIE App ID or DCN if it is related to an Application Registration task.
Automatically Routed Tasks
Tasks automatically routed by the system are not considered vendor errors. If the
system incorrectly creates a task during the auto-routing process, staff should follow
regional escalation processes for additional clarification and guidance.
The list below includes some forms that are automatically routed to the state queues:
 1010R – Your Texas Works Benefits: Renewal Form
 1014R – Children’s Medicaid Renewal
 Texas Women’s Health Program
o 1831 – Adjunctive Eligibility Letter
o 1867R – Texas Women's Health Program Medicaid Application
 1840 – Recertification for SNAP Benefits
 1842 – SNAP-CAP Renewal Application
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1869 – Renewal for Health Care Benefits (FFCHE)
SSP Applications
SSP Redeterminations
SSP Changes
MI/Change Routing Cover Sheet
Note: The system routes the 1010R and 1014R to the benefit office or CMC
queue based on the client’s residence zip code contained within TIERS.
The queue that receives the task is responsible for processing the task.
TIERS Alerts
TIERS creates alerts for agency generated changes. Many of these alerts are converted
automatically to TLM tasks and processed by CCC or other responsible area. There are
still TIERS Alerts that staff are responsible for processing such as Second Level
Reviews. Staff should continue to check their Welcome to TIERS home page daily, and
ensure the TIERS Alerts are processed appropriately.
TIERS Unavailable
There are two different types of ‘TIERS unavailable’ cases.
1. TIERS Down
When TIERS is completely unavailable, the application cannot be accessed.
 When TIERS is unavailable, it is unavailable statewide.
 TIERS access is unavailable; therefore TIERS specific data will be missing.
The only complete dataset is in TIERS.
 Typically when TIERS is unavailable, the State Portal is still available and
staff can access documents that have been imaged and appointments that
have been scheduled.
 When TIERS is available in a read only mode, staff should be able retrieve a
task from the Task List Manager (TLM) and read the TIERS Data Collection
screens. TIERS cannot be updated when in read only mode.
 When TIERS is unavailable benefits may be issued on the web-based EBT
system with appropriate approval. In order to issue benefits on the webbased EBT system, the client must complete a Form H1855 - Affidavit for
Non-receipt or Destroyed Food Stamp Benefits.
 Expedited or timely benefits may be issued using the web-based EBT
system. However, access is controlled by security measures, therefore only
appropriate staff are to carry out these tasks with appropriate approval.
2. TIERS Read-Only
When TIERS is in read-only mode, workers can access the TIERS application, but
data cannot be entered or edited.
Texas Health Steps Verification Process
In some instances, state staff must obtain verification of compliance with Texas Health
Steps. Below outlines the process.

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Texas Works worker prepares and faxes Form H1087 to the vendor for
processing. Staff faxes Form H1087 to 512-533-3867 or 512-533-3869.
ES State Processes
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December 2013
The vendor obtains the verification, completes the form and returns the
verification to the requestor.
If the requestor is unknown/unclear, the vendor faxes the complete form to the
appropriate Regional THSteps Liaison who will forward to the appropriate
individual.
TIERS Case Assignment
All Texas Works EDGs need to be assigned to the TAAGeneric worker and transferred
to the vendor office once a case is finished. This is done automatically by TIERS when
the case is disposed.
All MEPD staff has the ability to manually assign MEPD EDGs to a specific worker. If
the MEPD EDG is not assigned to a specific MEPD worker, the system will automatically
assign the EDG to the TAAGeneric worker upon disposition.
TLM will only consider MEPD EDG assignments, when routing tasks to the MEPD
Region Facilities queue for the programs listed below:
TA12
TP10
TP15
TP16
TP17
ME - State Group Home
ME – State School
ME – Non-State Group Home
ME – State Hospital
ME – Nursing Facility
If one of the above EDGs is assigned to an MEPD worker, the system will automatically
assign the task to the EDG owner and it will display in their personal queue.
If the EDG is assigned to the TAAGeneric worker or to someone who no longer is active
in the system or has access to TLM, the task will be routed to the MEPD Region Facility
TLM global as an unassigned task.
All other TLM task for MEPD will be routed to the appropriate MEPD Region, MEPD
Region Change queue based on case zip code regardless of TIERS case assignment.
Reporting TIERS/State Portal Tickets
When issues or problems arise in case processing through TIERS or the State Portal,
staff calls in tickets to get the problem resolved. There are two levels of help desk staff
that are available to assist.
Level 1 – ES Technical Help Desk
Level 1 staff can assist with the following items:




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TIERS system resets (“user already logged in” message)
TIERS password unlocks (“Account is locked for … Contact System
Administrator” message)
TIERS outages or system unavailability
MAXe CHIP issues
ES State Processes
December 2013
To reach the ES Technical Help Desk, call (800) 214-4175 or (512)438-4720 and press
option ‘1’ for assistance.
The ES Technical Help Desk is staffed from 8:00 a.m. to 8:00 p.m. Central Standard
Time, Monday through Friday.
Non-urgent issues can also be reported to the ES Technical Help Desk by sending an email to: IEE_HELP@hhsc.state.tx.us. The e-mail must contain employee name, phone
number, office location and description of the problem employee is experiencing.
Level 2 – TIERS Help Desk
Level 2 staff can assist with the following items:




TIERS/Portal functionality questions
TIERS/Portal software defects
TIERS/Portal data entry errors that cannot be corrected within the TIERS
application (Production Support Requests -PSRs)
TIERS/Portal escalations
EA TIERS Help Desk staff are responsible for requesting additional information and
provide instructions/resolutions to End Users.
When sending TIERS/Portal issues via e-mail to the EA TIERS Help Desk at
Tiersapplicationsupport@hhsc.state.tx.us, staff must complete the TIERS Help Desk
Issues Template.
Escalation of TIERS Tickets
Only tickets meeting the following criteria may be designated as "Escalated" and must
be processed using special procedures. While all issues are important, escalated
issues, by definition, have the potential to drastically impact our clients adversely. These
criteria apply to both Texas Works (TW) and Medicaid Eligibility for the Elderly and
Persons with Disabilities (MEPD).






Priority 1: High level complaints (Legislative, Executive Commissioner,
Ombudsman, etc.)
Priority 2: Office level complaints
Priority 3: Cases that are overdue and the resulting disposition would grant
benefits
Priority 4: Timeliness – resulting action would be certification of benefits and
would meet timeliness
Priority 5: Timeliness – resulting action would be denial and would meet
timeliness; within this priority level – case due date will also be used
Priority 6: Cases that are overdue and resulting disposition would be denial
(unless complaint)
Steps for Escalated Tickets
Staff must take the following actions when escalating tickets:
1. Follow established procedures to obtain first level triage/help from a
supervisor or designee.
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ES State Processes
December 2013
2. If the problem cannot be resolved and the issue is not policy-related, report
the issue to the HHS Consolidated Help Desk and provide the information
included in the template (Escalated Ticket Template – February 23, 2010).
3. Note: It is extremely important to provide as much information as possible in
order to accurately diagnose the issue and provide timely resolution.
4. Document the Help Desk ticket number in “Case Comments” and do not
make any additional changes to the case until instructed to do so by Help
Desk staff.
5. When a solution has been received, staff must report results back to the
Enterprise Applications (EA) TIERS Help Desk as soon as possible to ensure
timely resolution. Help Desk staff will remain available to receive the results
of the solution unless they were not able to contact the user initially to report
the proposed solution.
6. If a user does not respond to e-mail and/or voice mail messages from the EA
TIERS Help Desk staff on an escalated ticket, Help Desk staff have been
instructed to contact the secondary contact listed on the ticket.
7. If the case is due and a solution has been provided, the user will be required
to remain in the office until the case is disposed; may have to remain after
close of business hours.
8. If no one is available to dispose the case, the user or supervisor must notify
the EA TIERS Help Desk immediately.
9. If an escalated ticket has not been resolved within two days or more, then
staff must follow the Elevated Escalated Ticket Procedures noted below.
Elevated Escalated Tickets Procedures
End User Action
1. Employees must ensure the original ticket was escalated to the EA TIERS Help
Desk via phone or e-mail at IEE_Help@hhsc.state.tx.us
2. When it has been verified that the ticket was properly escalated, the user must
provide the following information to their supervisor via e-mail with "Elevated
Escalation Needed for <Ticket #>" in the subject line and use the established
ticket escalation Excel document – (Escalated Ticket Template – February
2010):
 Employee location
 Region
 Worker name
 Case name
 Case number
 Ticket number
 Due date of case action
 Date ticket opened
 Date ticket escalated
 Date ticket closed without resolution (if applicable)
 Brief summary of the issue
 Escalation Criteria
Supervisor Action
1. Verify the ticket was previously escalated to the EA TIERS Help Desk based on
the escalation criteria.
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ES State Processes
December 2013
2. Ensure the employee provides the required Ticket Escalation documentation and
that the information is complete.
3. Route the information via e-mail to the appropriate regional escalation contact(s)
listed below:
Region
Point of Contact
Phone Number
Back Up Point of
Contact
Phone Number
1
Francis Pena
806-457-5231
Patrice Price
806-766-2728
2/9
Kathy Weber
325-866-7506
Melody Trimble
325-659-7650
3
Linda Autry
972-337-6147
Sherry Pressnell
972-337-6241
4
Robert Heflin
903-927-0227
Bob Kupke
903-581-9243
5
Steve Allison
936 544-3850 x224
Bonita Gosey
409-423-7551
6
Margaret Boehme
713-767-2443
Jackie Ross
713-696-3679
7
Melba Hills
512-897-7940
Sandra Dillett
512-788-4397
8
Dee Ann Smith
210-619-8260
David Garcia
210-619-8030
10
Kate Hill
915-759-3477
Mary Tovar
915-872-5901
11
Henry Howell, Jr.
956-316-8143
Juan Gonzalez
956-316-8274
CCC
Craig Pauler
512-533-3655
Sandy Holguin
210-304-5719
MEPD
Martha Meazell
254-629-1713 x3077
Sally Lopez
830-426-7543
ART
Willann Thomas
979-776-7417
Bill Brown
281-597-5214
Escalation Contact Action
1. Verify the ticket meets the escalation criteria.
2. Verify the employee/supervisor provided all the necessary information noted
previously.
3. Route the information to Enterprise Application contacts for investigation.
4. Monitor escalated tickets to ensure resolution and escalate any unresolved
issues to regional management.
EA Help Desk Action
1. EA TIERS Help Desk employees ensure ticket resolution and response is
provided to the user, their supervisor, and the escalation point of contact as soon
as possible.
2. The TIERS vendor is required to respond to escalation requests within 48 hours.
Help Desk Contact and Hours of Operation
Contact the HHS Consolidated Help Desk at (800) 214-4175 (option “1”) from 8:00 am to
8:00 pm Central Standard Time (CST) or email tiersapplicationsupport@hhsc.state.tx.us.
This is the TIERS Application Support mailbox in Outlook. The mailbox is monitored
until 7:00 pm CST on workdays until 3:00 pm CST on Saturdays.
Help Desk Ticket Processing Issues
Staff should apply the process below when encountering issues related to the
processing of Help Desk tickets. Help Desk ticket processing issues include, but are not
limited to, the following:
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ES State Processes
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December 2013
Tickets closed without resolution
Pressing issues not addressed in a timely manner
Tickets for which inaccurate or insufficient information is given, etc.
Escalation Process
If a Help Desk processing issue is encountered, follow the steps below.
1. Staff member escalates the issue to their supervisor or person acting in a
supervisory capacity.
2. Supervisory staff reviews the issue to determine if further escalation is needed.
3. If escalation is needed, supervisory staff routes the issue to the Enterprise
Applications staff at the email address below:
Mailbox Display Name: HHSC EA Business Automation
E-mail address: EA_BusinessAutomation@hhsc.state.tx.us
Email Format
The subject line of the email should include the following:
 Action Needed or Informational
 Help Desk ticket number
 Identify issue: Closed but not resolved, Not addressed timely, Inaccurate
information, etc.
Example: Action Needed: Ticket #1426921, Closed but not resolved
The body of the email should include the following:
 Region
 Case Number
 Detailed description of the issue
 User ID and contact information of the worker experiencing the issue
Data Broker Resolution
All Data Broker issues need to be escalated to the state Data Broker Coordinator via the
Regional Data Broker Coordinator to determine the best solution resolving the issue.
The Regional Data Broker Coordinator e-mails the information gathered to the state
Data Broker Coordinator, Laurie Hoelscher at laurie.hoelscher@hhsc.state.tx.us, who
will jointly resolve the issue with Dallas Computer Systems (DCS). The regional
coordinator is notified via e-mail when the issue is resolved. All Regional Data Broker
Coordinators will receive notification on significant issues and be instructed to inform
their regional users of these issues. Regional users DO NOT need call the Help Desk to
report known problem issues that are in the process of resolution.
Note: DCS is not to be contacted directly by regional users or Regional Data
Broker Coordinators.
Task Failure Processing
In some instances, the system is unable to determine which queue to route certain tasks
such as Application Registration or Schedule Appointment tasks because the client’s zip
code is not mapped to a location. The system will create and route a ‘Process a TLM
Task Failure’ to the Task Failure location when this occurs, Designated staff will be
responsible for reviewing the information to determine the reason for the task failure.
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Out-of-State Zip Code
If the client’s zip code was an out of state zip code, they will process the action as an
Out of State application in TIERS. Once processed, the staff will mark the task as
‘Complete’.
Incorrect Zip Code Entry
If the client entered an incorrect zip code and the client’s correct zip code is currently
mapped to an office, the staff will determine the correct zip code and enter the new zip
code information on the address screen when performing application registration. Using
the correct zip code will ensure the task is routed to the appropriate queue based on the
client’s zip code and program(s) requested. Once processed, the staff will mark the task
as ‘Complete’.
Zip Code Not Mapped
If the client’s zip code was correct but had not been mapped to an office, they will mark
the task as ‘Update Zip Code’. This will create a ‘Process a Zip Code Update’ task to
be processed by designated State Office staff. The designated State Office will:
 Claim the ‘Process a Zip Code Update’ task.
 Work with the region and update the Office Locator appropriately.
 Once the Office Locator is updated, staff will register the application in TIERS so
the process task is created and routed to the appropriate queue based on the
client’s zip code and program(s) requested.
 Once the appropriate task is created, they will mark the ‘Process a Zip Code
Update’ task as ‘Complete’.
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XVI. SUPPORT TOOLS
The State Processes document contains specific instructions and also refers to several
Support Tools for ease of use and quick reference. Use both documents to ensure
proper processes are followed. Below is a brief overview of each Support Tool.
The TIERS Help Desk Issues Template should also be used when sending TIERS
issues to Level 2 TIERS Help Desk staff.
Also, if additional information is needed; other Reference Guides and Job Aids may be
accessed from the OFS website at: http://ofs.hhsc.state.tx.us/TAC/ESASK_Materials.aspx . This information is provided by the Enterprise Applications
Application Support and Knowledge (ASK) team and it can be viewed online, saved in
Favorites or to your desktop, or printed for future reference.
Document Routing Procedures
This Support Tool communicates the procedures for scheduling and routing documents
for TIERS clients in TIERS Eligibility Offices. Most documents will be processed in the
Eligibility Office from end-to-end.
Complete Action and Disposition Coordination
This Support Tools provides staff with expectations regarding Complete Action
processing and disposition coordination.
Document Upload
This Support Tools provides staff with information on how clients can upload verifications
to yourtexasbenefits.com from their home computer or other external location. The
document upload functionality cannot be performed on the HHSC lobby computers. It
also includes basic system operating requirements needed for this activity.
First Time Sign-On Procedure for State Portal
This Support Tool walks first time users through signing in to the State Portal. Users will
have to change the default password.
Ordering ES Materials
This support tool provides an overview of the process through eligibility staff will order
and receive new eligibility system/ES envelopes, applications and forms.
Re-Linking Images
This Support Tool instructs users on how to re-link imaged documents in the State Portal
to the correct TIERS case.
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State Portal Supervisor
This Support Tool assists Supervisors in performing managerial functions using the
State Portal. It includes instructions on how to publish, update, and view office
schedules, and will aid in managing and monitoring workloads.
State Portal TLM
This Support Tool aids workers in using the State Portal to manage daily workloads. It
assists users in effectively navigating in the Task List Manager.
TIERS/Portal Security Roles – MOR Workload Transfer
This Support Tool provides information on steps needed to handle TIERS and Portal
Security Roles when an individual is resigning from HHSC or moving to a new TIERS
location. Staff must following these steps as well as complete the MOR Workload
Transfer Sheet and Form 4743A appropriately.
Escalated Ticket Template
This document is used to provide detailed information regarding TIERS/Portal ticket
information.
Self Service Portal Application Registration
This document serves as a quick reference for staff responsible for performing
Application Registration for applications submitted via SSP.
Reminders
This document provides information on the steps client’s follow if they wish to sign up for
electronic reminders.
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XVII. GLOSSARY OF TERMS
Term
Application Support (AS)
Area Information Centers (AIC)
Assistance Response Team
(ART)
Automated System for Office of
Inspector General (ASOIG)
Budgeted Job Number (BJN)
Central Processing Center (CPC)
Centralized Benefit Services
(CBS)
Children’s Medicaid Center (CMC)
Community Based Alternatives
(CBA)
Community Based Organizations
(CBO)
Community Partners (CP)
Contingency Processing Method
(CPM)
Customer Care Centers (CCC)
62
Description
Vendor employee’s who link scanned or faxed images to TIERS cases,
reschedule appointments, review verification documents and route work
to state staff.
Available via 2-1-1, their primary purpose is to maintain information
about human service resources in the community and to link people
who need assistance with appropriate service providers. In Texas, this
service is provided through certified staff at twenty-five contracted Area
Information Centers.
State staff responsible for assisting other regions.
The automation system that distributes Income and Eligibility
Verification System (IEVS) data matches and Interstate matches to OIG
and MEPD staff to clear and create overpayment referrals in the ASOIG
Investigations module. Overpayment and fraud referrals are entered
into ASOIG or transmitted through an interface from TIERS. The
system allows users to track referrals, manage investigations, and
establish overpayment claims through an interface to the Accounts
Receivable Tracking System (ARTS).
A unique set of numbers for an employee that identifies the particular
location and budget the employee’s position is assigned to.
Centralized staff responsible for processing TIERS CHIP to Medicaid
referrals that are received from the CHIP vendor. They also process
emergency Medicaid benefits for CHIP perinatal mothers.
Centralized staff responsible for processing statewide
applications/redeterminations for FS-SSI, MTFCY, HC-FFCHE, RMA,
SNAP, TYC/JPC youth and MBCC.
Centralized regional staff responsible for processing Children’s
Medicaid applications and renewals for designated region(s).
Provides a wide variety of home and community-based services to the
elderly and persons with disabilities as cost-effective alternatives to
institutional care in nursing facilities.
Approved organizations that connect individuals in need with services
available in their communities or provide a service directly.
Organizations that operate at the local level to provide services and
assistance to community members in need. They also applicants filing
for benefits and authorized contracted Partners may perform SNAP
interviews. These organizations are also called Community Based
Organizations (CBOs).
An alternate method of processing cases when there are outstanding
system issues.
Customer Care Center (CCC) is a virtual region located in six cities
across the state. They are located in Athens, Austin, El Paso, Houston,
Midland and San Antonio. CCC also includes a variety of centralized
areas, including CCC Core, Central Processing Center (CPC),
Centralized Benefit Services (CBS) and Texas Women’s Health
Program (TWHP).
ES State Processes
Term
Customer Care Representatives
(CCR)
Dallas Computer System (DCS)
Data Integrity (DI)
Document Imaging
Document Processing Center
(DPC)
Drug and Alcohol Treatment
Facility (D&A)
Eligibility Services Staff (ES)
Eligibility Support (ES)
ES-Centralized Representation
Unit (ES-CRU)
Former Foster Care Children
(FFCC)
HHSC Eligibility Office
Health Care for Former Foster
Care in Higher Education (HCFFCHE)
Income and Eligibility Verification
System (IEVS)
In-Flight Queue
MAXe IE
Medicaid Buy-In (MBI)
Medicaid Buy-In for Children
(MBIC)
Medicaid for Breast and Cervical
Cancer (MBCC)
63
December 2013
Description
Vendor employees who provide clients with an overview of eligibility
programs and services, answer application and eligibility questions,
take changes and assist with screening and application completion.
Vendor who provides data broker information to the state.
Specialized unit within ES that processes ME SSI Medicaid, Medicaid
for newborns, Biographical corrections, Spend-Down,
Merges/Separates, Buy-In, QI-1 and Managed Care corrections.
Process of scanning documents and saving them as electronic files in
the new eligibility system for online access and viewing.
Located in Midland, vendor staff in this facility receive, process, and
image all inbound documents.
Facility that provides treatment for alcohol and chemical dependency.
Staff is individuals who provide eligibility determination services as part
of their primary job responsibilities. This includes Texas Works and
MEPD staff.
Process of integrating the application and eligibility determination for
applicants seeking assistance with Medicaid, Food Stamps, TANF and
MEPD services.
Staff who process fair hearing packets and serve as the agency
representative for most fair hearings.
Type of assistance under ACA that covers former foster care children
up to age 26 who were receiving federally funded Medicaid when they
aged out of Foster Care.
Full-service offices where HHSC staff use TIERS to provide eligibility
determination and benefit issuance services. (Previously known as
“local offices” or “field offices”)
A program to provide health coverage to an individual who: Is at least
21 years of age plus one month, through the month of their 23rd
birthday; must have been in Foster Care on their 18th birthday; is
enrolled in an institution of higher education in Texas.
An automated system that matches various types of benefits and
income with other state and federal agencies. (Ex: wages,
unemployment compensation, special benefits, SSA and SSI benefits,
and IRS records of unearned income)
A view displaying details of the task being worked including any
outstanding tasks associated with the case.
The database that the vendor uses to collect, process and store data.
The MBI program allows people of any age who have a disability and
who are working to receive Medicaid by paying a monthly premium.
The program is worked solely in TIERS by MEPD staff.
The MBIC program allows children up to age who have a disability and
with gross family income of up to 300% FPL to receive Medicaid by
paying a monthly premium. The program is worked solely in TIERS by
MEPD staff.
A special Medicaid program authorized by federal and state laws to
provide access to cancer treatment services for qualified women.
ES State Processes
Term
Medicaid for Pregnant Women
(TP40)
Medicaid for Transitioning Foster
Care Youth (MTFCY)
Missing Information (MI)
Office of the Attorney General
(OAG)
Outstationed Workers
Process
Redeterminations
Refugee Medical Assistance
(RMA)
Refugee Voluntary Agency
(VolAg)
Request for Review (RFR)
Service Authorization System
(SAS)
Simplified Nutritional Assistance
Program (SNAP)
Social Security Administration
(SSA)
Special Escalation Unit (SEU)
State Portal (STP)
64
December 2013
Description
Medicaid coverage for pregnant women to assist in the prenatal care
and birth of the child. Coverage is received two months following the
birth of the child.
Medical coverage for youths aging out of foster care. The Texas
Department of Family and Protective Services (DFPS) administers the
foster care program. Youths who age out of foster care may receive
Medicaid from age 18 through the month of their 21st birthday if they
meet all of the eligibility criteria.
Incomplete or missing information needed to complete an eligibility
determination. (Previously known as “pending information”)
Serves as legal counsel to all boards and agencies of state
government, issues legal opinions when requested by the Governor,
heads of state agencies and other officials and agencies as provided by
Texas statutes, sits as an ex-officio member of state committees and
commissions, and defends challenges to state laws and suits against
both state agencies and individual employees of the State.
HHSC workers located at hospitals, clinics, or nursing facilities who
determine eligibility for applicants in these facilities. Some of the
outstationed workers are also housed in the Eligibility Offices.
A defined set of steps/procedures for completing common agency
tasks.
Term used to define applications submitted to renew/review all program
certifications.
The Refugee Medical Assistance (RMA) program is100% federally
funded. RMA program provides medical assistance to refugees who
have lived in the United States for eight months or less from the date of
entry.
An agency that contracts with the U.S. Department of State to help the
refugee/entrant with basic needs for up to 90 days. As a rule, every
refugee/entrant is represented by a VolAg.
A process by which a FFCHE or CHIP client who disagrees with the
results of their case processing may formally request in writing that the
results be reviewed.
This is a part of the payment system for the Department of Aging and
Disability Services (DADS) and MEPD providers.
A six-year demonstration project that outreaches elderly SSI recipients
who are not currently certified for Food Stamps. Aka SNAP-CAP
Is an independent agency of the United States government that
manages the United States' social insurance program, consisting of
retirement, disability, and survivor’s benefits.
Specialized vendor staff assigned to investigate issues that cannot be
resolved at a lower level. These issues may include but are not limited
to complaints, scheduling and interview errors, and phone calls from
clients needing assistance.
A single sign-on application where HHSC staff initiate tasks or work
assignments, launch TIERS, view images and schedules, record
complaints/ requests for fair hearings and perform other activities
related to eligibility determination.
ES State Processes
Term
Task
Task List Manager (TLM)
Task List Manager (TLM) Global
Queue
65
December 2013
Description
An eligibility related work item that is sent to state staff via the State
Portal and visible in the TLM Global Queue or TLM Personal Queue.
An online software application that lists tasks for state staff in Eligibility
Offices, ART, MEPD and CCC. Staff selects tasks based on workload
availability or assignment. The TLM Global Queue and TLM Personal
Queue are used to receive and monitor activities and due dates. The
user role determines the tasks staff can view.
A list of tasks that may be claimed based on user roles and location.