109-9          ADDITIONAL GUIDELINES

Although the desk guides and templates are designed to inform staff about information they need to include in specific CANOCase Notes entries, the following sections provide additional guidelines to further clarify expectations for documentation in important areas affecting eligibility determination and benefit amount.

109-9 A.      USING CANOCase Notes TITLES

Staff must always remember that CANOCase Notes titles should reflect what is in the body of the CANOCase Notes. Titles must be clear, descriptive, and specific. Several recommendations and examples of CANOCase Notes titles are provided below.

Note:

When creating CANOCase Notes titles for applications and reapplications, staff must always include the program name, date of application, and action.

1. Title Formats, Keywords, or Phrases

To easily locate information in a CANOCase Notes, the following wording or phrases must be included in titles:

• ROC - ADDR/EAIN/DEMH – case action
• ROC - Job Changed – case action
• ROC - New HH member – case action

• TA /FS /ME App – date of app – (approved/pended/denied)

• TA /FS /ME Recert – date of recert – (approved/pended/denied)
• Information rec'd/date/action or still pended
• Fair Hearing Request with Finding
• Prehearing Conference with Action (forwarded/resolved)
• Fraud Referral
• ATAP Incapacity Determination
• Case Corrections for QA Review

• Type of Penalty Imposed/Ended/Deleted with date of action to occur

• Penalty Advanced to 75% with effective date
• Disqualification and Programs
• Trust Established
  * Initial Case Note; refer to ADLTC Medicaid MS 528-E
• Trust Information
  * For additional information received
• Medicaid (type) Trust (renewal)
• Transfer of Assets and Resources (effective date)
• Tax Refund Exempt (effective date to end date)
• TLIP Update Request
• Spend-down (program type) (effective date)
• LOC, DDS, and Comagine Health Determination (include agency name/date/favorable or denied)
• POA, Guardians, and Payee
• ATAP Incapacity (name) (effective date to end date)
• Drug-related or Other Felony Convictions for (name)
• Unusual Alien Situations regarding (name)
• Intentional Program Violation
• Cold Call (# of attempt)

2. Examples of CANO Titles

Some examples of good CANO titles are provided below:

• ROC – EAIN/ADDR – PENDED
• ROC – ALERT/UIB – BENEFIT CHANGE
• TA/FS/MED APP – 5/5/11 – APPROVED
• FS/ME REVIEW – 8/8/11 – PENDED
• FS/ME REVIEW CONT – 8/8/11 – DENIED
• FS/ME REVIEW – 8/24/11 – FS DENIED/MED AUTH
• INFORMATION REC'D 7/1/11 – STILL PENDED
• WA PENALTY IMPOSED 8/1/11 – CHANGE OF BENEFITS
• PREHEARING CONFERENCE 8/4/11 – RESOLVED
• FAIR HEARING – AGENCY UPHELD
• PENALTY ADVANCED TO 75% – 8/1/11
• DISQUALIFICATION – FS
• TRUST ESTABLISHED 8/2/11 (type – SNT/QIT/Pool)
• TRUST INFORMATION 8/24/11
• MEDICAID (type) TRUST – RENEWAL – 9/1/11
• TRANSFER OF ASSETS AND RESOURCES – 5/12/10
• TAX REFUND EXEMPT – 1/11 THRU 1/12
• TLIP UPDATE REQUEST EFFECTIVE 6/1/11
• SPEND-DOWN (program type) 2/1/11
• DDS DETERMINATION – 8/4/11 – FAVORABLE
• POA, GUARDIANS, AND PAYEE
• ATAP INCAPACITY (name) FROM 5/21/11 – 10/12/11
• DRUG-RELATED OR OTHER FELONY CONVICTIONS FOR JIMMY
• UNUSUAL ALIEN SITUATION REGARDING SALLY
• COLD CALL (#1)

109-9 B.      USING ABBREVIATIONS AND ACRONYMS

Staff may use common abbreviations, acronyms, and EISEligibility Information System Codes in CANOCase Notes documentation. They are generally used to shorten phrases in order to save space or to avoid awkward repetition of phrases. When using acronyms and abbreviations, follow this guideline:

• Utilize the list of commonly used abbreviations and acronyms in DPADivision of Public Assistance (available as Addendum F).
• When using a word or phrase, that is not on the list, spell the phrase out and follow it with the abbreviation or acronym in parentheses. This ensures the reader clearly understands the meaning of the abbreviation or acronym and what it is being used for. This rule applies to each new CANOCase Notes that staff creates.

109-9 C.      CREATING CANOCase Notes FOR REVIEWS AND RECERTS

The CANOCase Notes format is pertinent to both intake and maintenance processing. The purpose of conducting a review or recertification is to determine continued eligibility and establish a new certification period. The CANOCase Notes for a review or recert CANOCase Notes should address must of the same information addressed in the documentation supporting a determination made on an initial application.

109-9 D.      DOCUMENTING INCOME INFORMATION AND CALCULATIONS

The income and calculation information used to determine program eligibility must be uploaded in ILINX (paystubs, employer statements, interfaces, etc.) or documented in the CANOCase Notes (collateral contacts, etc.). The income recorded on the eligibility screens must match the provided documentation.

Clear documentation of income calculations is critical for every eligibility determination. Document all income, how it was verified, and calculated for each budget month.

If a pay stub is missing or if there is an unusual pay stub that exists, staff need to seek clarification from the employer and this information must be clearly explained. 

109-9 E.      DOCUMENTING DISABILITY INFORMATION

The subject of disability is pertinent to all programs (incapacity for ATAPAlaska Temporary Assistance Program, exemption for SNAPSupplemental Nutrition Assistance Program disability for APAAdult Public Assistance / IAInterim Assistance, CAMAChronic and Acute Medical Assistance, and Medicaid). Staff must determine if disability exists in the home and document it accordingly.

Staff must not include sensitive information such as medical diagnosis or condition in CANOCase Notes. Refer to MS 109-3 for additional information on documenting sensitive information.

109-9 F.      DOCUMENTING RIGHTS AND RESPONSIBILITIES

Program rules require staff to discuss rights and responsibilities with all applicants and complete the documentation process. Supervisors and case reviewers cannot assume that staff discussed the Rights and Responsibilities form (GEN 51Your Rights and Responsibilities) with the client. Staff must document that rights and responsibilities were discussed with the client and note any other relevant information about the discussion. This will generally be done on the PAIR 1 form.

There are situations when the R&RRights & Responsibilities must be reviewed with the client and documented in the CANOCase Notes. These situations can be when the worker needs to reiterate sections of the R&RRights & Responsibilities in the course of a conversation.

If the interview was conducted by a fee agent, document that fee agent has discussed rights and responsibilities to the client and given the client a copy of the GEN 51Your Rights and Responsibilities as indicated in the fee agent checklist.

109-9 G.      DOCUMENTING TPLThird Party Liability CODES

Documenting Third Party Liability (TPLThird Party Liability) for Medicaid cases is necessary to assist Health Care Services in billing the appropriate agency. When TPLThird Party Liability exists in a case, the following information must be included in the CANOCase Notes entry:

• the insurance code
• the name of the primary insured person and their place of employment if available
• the date the insurance began
• if the worker verifies insurance has ended, the date it ended should be annotated and how verified

109-9 H.      DOCUMENTING CASE CORRECTIONS FOR QAQuality Assessment ERRORS

Clear, concise documentation is required for every case correction made as a result of a QAQuality Assessment error finding. Staff in the Program Integrity and Analysis Unit checks EISEligibility Information System to ensure the case corrections are completed. When documenting case corrections for QAQuality Assessment errors staff must:

• Use standardized CANOCase Notes title to assist Program Integrity & Analysis in easily finding the case information, e.g., Case Corrections for QAQuality Assessment Review #              .
• Include a brief description of the error finding, the amount and months of the overpayment or underpayment, and an explanation of how it was calculated.

The same documentation guidelines apply when submitting a fraud referral as a result of a QAQuality Assessment error and when closing a case after the household fails to cooperate with the QAQuality Assessment review.

109-9 I.      DOCUMENTING RETURNED MAIL

DPADivision of Public Assistance applicants and recipients are responsible for providing accurate and updated addresses when applying for and receiving benefits. When DPADivision of Public Assistance offices receive returned mail, refer to MS 103-4 for process guidance. If documentation is necessary, include the following information:

• Reason for the return. Some examples of language used by the postal service include: undeliverable as addressed, unclaimed, unable to forward, attempted not known, no forwarding address, no mail receptacle, attempted – not known, insufficient address, etc.
• Action: this may include action taken to verify the address was incorrect or if a new address exists or any case determination made.
• Notice of action sent to the household.