Prior Quarter Guided Change Wizard

 

Prior Quarter (PQ) coverage allows a participant to receive healthcare coverage for up to three months prior to the month of application.

 

Prior Quarter Income is always entered as the Actual income for the Prior Quarter month(s). The Start and End Date of Prior Quarter evidence (MO PQ Income, MO PQ Deductions and MO PQ Medical Bills) start and end dates must cover the 1st through the last day of the given PQ month.

 

The following information is needed when entering PQ request in the eligibility system:

    • Specific month(s) requested
    • Is there a need
    • Are there medical bills
    • Any income received in the requested month(s)

 

For registering new applications, refer to the Entering an Application.

 

This user guide should be used when requesting PQ benefits on an:

 

    • Application Case (AC), when the participant requested PQ benefits after the application was registered but prior to authorizing, or PQ benefits were requested on the application but were not entered while registering the application.
    • Integrated Case (IC), when the participant requesting PQ benefits has not had active coverage longer than the last 12 months. Changes made to existing ICs for participants with coverage greater than the last 12 months should be made following prescribed Change in Circumstance procedures.

 

Note: If PQ is not added via the Guided Change Wizard, the eligibility system will not generate a PQ Product Delivery Case (PDC) causing errors in coverage.

 

If you are requesting benefits for a new household member, first add the new participant using the Add a Person.

 

Training Resources: Prior Quarter Take 10

 

Tools: Date Calculator

 

TO REQUEST PQ FOR A MEMBER USING THE GUIDED CHANGE

    1. Navigate to the Application Case/Integrated Case > Page Actions menu
    2. Hover your mouse cursor over Guided Change and select Request PQ for a Member

NOTE: If the participant requesting Prior Quarter coverage has not provided the needed information regarding Prior Quarter coverage, utilize First Contact Resolution to attempt to collect the missing information.

 

    1. From the Participant Details tab, select the participant requesting PQ benefits from the drop down menu
    2. Click Next
    3. On the Prior Quarter Information tab, click the check box for each of the following:
      1. If missing PQ information, answer yes to all questions for the 3 PQ months.
        1. Which of the following 3 months is participant requesting benefits
        2. Which of the following 3 months did participant have medical bills
        3. Which of the following 3 months was participant a Missouri resident
    4. Click Next
    5. On the PQ Income tab, complete the following for the participant applying for PQ only
      1. If missing PQ information, enter income for each PQ month, using ongoing income unless otherwise indicated
        1. Select the Income Type from the drop down list
        2. Enter the Employer
        3. Enter the income Amount
        4. Select the month during which the income was earned
    6. Click Add/Save Income
    7. Repeat steps 7 – 8 for each type of income, for the selected member

NOTE: If the IC already has duplicate PQ Income evidence for the PQ months, you do not need to enter it again on the guided change. If the income for PQ months has NOT been entered, enter the income for the selected participant and then create PQ Income evidence for the remaining household participants by creating new evidences on the dashboard.

 

    1. Click Next
    2. On the PQ Deductions tab, complete the following
      1. Select the Deduction Type from the drop down menu
      2. Enter Additional Information
      3. Enter the Amount
      4. Select the month during which the deduction was claimed
    3. Click Add/Save Deduction
    4. Repeat steps 11 – 12 for each type of deduction and month for each household member
    5. Click Next
    6. Review the Summary and click Finish
    1. Verify All Outstanding Verification

NOTE: If you cannot verify all three months of PQ Income, and the participant does not respond to the IM-31A within 10 days, MEDES will automatically reject ALL THREE PQ months when PQ is requested.

 

    1. Complete case processing;
      1. AC: Validate Changes and Check Eligibility, Authorize Case
      2. IC: Apply Changes; Authorize PQ Coverage; Check Proposed Determinations; Finalize Proposed Determinations

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generates an additional proposed determination, you must Finalize Proposed Determinations again.

 

    1. Make a comment on the HoH Person page to include
      1. Who requested PQ benefits
      2. Any change in coverage
    1. Review Notice Queue to make sure appropriate forms generated
      1. IM-33APQ: Prior Quarter Approval
      2. IM-33RPQ: Prior Quarter Rejection
      3. IM33ARPQ: Prior Quarter Approval and Rejection
      4. IM-33C: Case Action Notice
For a quick guide to eligibility and coverage start dates please see. Medicaid Categories/Coverage Type w/ME Codes and Processing Timeframes