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CCI Pre-Authorization Review Process SOP

Purpose: #

To ensure agency goal of SNAP payment accuracy of 94% is maintained by focusing on error prone areas and providing meaningful feedback for a positive learning experience.

 

Criteria: #

Cases that meet BOTH of the following criteria must be sent for a Pre-Authorization review. 

  • $200+ EARNED income ongoing; AND
  • $200+ benefit amount ongoing.
    • DO NOT send cases with self-employment
    • If the income is ended and will therefore not be ongoing, do not submit for review.

Note:

  • This includes all SNAP case actions ready to authorize and is not limited to SNAP interviews. (Applications, Recertification, Mid-certification reviews, change in circumstance, etc.)
  • All comments are to be completed prior to submitting.

Do NOT submit:

  • Cases that are RTA for expedite but pending ongoing months.
  • Cases that are pending, rejecting or closing. 

 

Process: #

  • Prior to 3pm, staff will submit all cases that meet the listed criteria to the CCIU hand off for case review.  *If working overtime during regular business hours, cases that meet Pre-Authorization criteria should still be submitted.
  • Leave the case in RTA status in FAMIS until the review is completed. 
  • The Application or MCR must be through the Controlled Flow and EDRES’d. 
  • The change in circumstance must be EDRES’d. 
  • Please do NOT remove any verification codes to cause the case to pend.
  • Enter the following comment on EUMEMROL prior to submitting for review:
    • Comment Label: Left in RTA status – case meets pre authorization criteria
    • Comment Line:  Case was left in RTA status pending review.  Will authorize once review is completed.
  • After 3pm, staff will submit all cases that meet the listed criteria to the Supervisory case review hand off.  If the case is expedite eligible or due today AND there are no Supervisors available to read your case, authorize the case and do not submit.
  • If it is within 1 hour of your scheduled leave time, do not submit the case to either portal.
  • Enter the following comment on EUMEMROL:
  • Comment Label: Case not submitted for Pre-Authorization             
  • Comment Body:  Past cut off time for submission (insert time)

Supervisor Note: Send all cases that meet Pre-Authorization criteria prior to 3pm to CCIU.  This includes probationary case reads during OJT and Post OJT excluding over the shoulder Pre-Authorization reads.

  • Comment Label: Left in RTA status – case meets pre authorization criteria
  • Comment Body:  Case was left in RTA status pending review.  Will authorize once review is completed.

NOTE: If you do not receive a response from CCIU by the end of your work day, your case most likely did NOT meet the pre-authorization criteria and was not reviewed.  If you feel this is in error, speak to your supervisor for follow up.

 

Current Process: #

When a case has been identified as meeting Pre Authorization criteria and you are ready to submit the case for review:

  • Pause the case, using the reason code “CCI Read/Review”
  • Click “Apply”

Once the review is complete:

  • Locate the paused case on your worker dashboard
  • Make corrections and/or authorize the case the same day the review is completed
  • Select the appropriate outcome
  • Click “Done”

 

Genesys Process: #

If on a call and the case is identified as meeting CCI Pre Authorization criteria:

  • Once you have finished all work on the case, use Wrap Up time to complete the referral to the CCI unit.
  • Once finished with referral, move on to the next call until you receive a response from the case reading.

When a case comes back for correction, staff member should go off queue and use “CCI Correction Status” to review and complete any case corrections.

What to tell the client?

“We have everything we need to process your case. Your case will be reviewed today to ensure you receive the correct amount of benefits.  You can check the status of your case tomorrow either by going online at mydss.mo.gov or you can hear the status of your case by calling 855 373 4636, press 1 for SNAP and enter your DCN and Date of Birth.  You will also get a letter in the mail once the case has been processed.”

 

How to submit your case for Pre-Authorization: #

In SharePoint > New Worksite:

  • If prior to 3pm select the Pre-Authorization Review button to submit case to CCIU review.
  • If after 3pm select the Supervisor Review button to submit case for supervisory review.

After selecting the review button, the submission form below will open.

Answer the screening questions:

  •  Does this household have countable self-employment Yes/NO? 
  •  Has this household been approved for $200 or more in on-going benefits and left in RTA status YES/NO?    
  •  Does this household have on-going earned income of $200 or more YES/NO?

Note: It is very important to submit only cases that meet Pre-authorization criteria.

Enter the DCN and CASE NAME and then click the Save   button.

  • NOTE: If you have a case that is DUE today (30th day) you will need to click on the Click Here if Case is Due Today button.
  • If the customer is in a FSD Resource Center click on the Click here if Customer is in Office button
  • A white check mark will populate and this will elevate the case for CCIU.

What happens next?

  • The case will be reviewed by CCIU or field Supervisors.  CCIU will review Earned Income, Income Frequency, Household Composition, Shelter Expenses and DC Expenses.
  • You and your supervisor will receive an email when case has been reviewed to advise if the case is correct or needs adjustments.
  • If the case is CORRECT, you will authorize when the reading is returned; however, review the COMMENTS as there may be suggestions for things that need review but did not cause a payment error.
  • If the case is INCORRECT, you will make needed corrections and authorize the case same day or pend if necessary. There is no need to resubmit the case.
  • Some examples of most common errors noted have been incomplete comments, no follow up on inconsistent information, not addressing inconsistent pay information, etc.
  • Once a case has been submitted do not continue to work on the case until the reading has been returned.
  • If a reading is not returned from CCIU timely and it meets Pre Authorization criteria or if a reading is returned from CCIU and the comments are unclear, reach out to your supervisor for follow up with CCIU.

 

Q&A: #

  • Q: If staff enter verification and it is not for income, do they still need to submit the case for a Pre-Authorization reading? – A: Any case meeting Pre-Authorization criteria and in RTA status should be submitted if within the allotted timeframe (prior to 3pm cut off or one hour prior to the end of shift).
  • Q: If staff enters verification but do not authorize the case (ex: customer did not provide all requested verification) do they still submit for pre-authorization read? A: No, because if the customer did not provide all requested verification the case would still be pending, we do not submit pending cases.
  • Q: What if this was a tough case and I don’t want to submit it to be reviewed? A: This is not an optional process. All cases that meet preauthorization criteria, are in RTA status and or 1 hour prior to the end of shift should be submitted. 

Revised 02/23/24

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