Case records are required for all assistance cases and are to be separate from social service records. The eligibility record shall include required forms to establish eligibility for assistance and additional information and decisions reached regarding eligibility, the type of assistance, notices to the client, and authorization forms.
The case record includes all information about all individuals on a case. The case record is comprised of three (3) main components: 1) All medical information input into KEES, including specified person-level information which may be accessed across medical cases, 2) The medical eligibility record held on KEES, and 3) medical information and documentation in the case file.
The eligibility record also includes output of KEES which is transferred to the MMIS for claims payment and MCO assignment. All data input into KEES is a part of the eligibility and case record.
The case file is the collection of medical documents that support the information contained in the state eligibility system as well as all other medical documentation that relates to the case. Any information received, in any format, in relation to a case must be in the case file. The case file contains all documentation supporting case processing activities. This includes, but is not limited to, application forms, income verification and worksheets, correspondence, legal documents, requests for case maintenance, a log of case actions and customer contacts, and previous eligibility information for the members of the household.
For the purpose of uniformity and convenience in use, the material contained in an electronic storage system is presented in chronological order. Staff are responsible for ensuring all documents are indexed correctly according to the KEES User Manual.
Correspondence plays an important part in the functioning of the program and for this reason much care is needed in planning correspondence. Notices affecting the eligibility shall become a permanent part of the agency's record and are captured by the eligibility system and/or imagining system.