All EN Payments Call

April 28, 2015

Agenda

• Common Payment Denials

• When to use an “Employer Prepared Earnings Statement” vs an “EN Supplemental Earnings Statement”  

• New Ticket Portal presentation Q & A review

• Q & A

2

3

Payment Denials FY 2014Beneficiary Receiving

Cash Bene-fits

44%

Not Eligible for Payment Due to Look Back Earning

13%

Due to VR Ser-vice, Phase 1

Milestone Can't be Paid12%

Earnings Amounts Do Not Meet Crite-

ria for Payment9%

Duplicate Request - Payment Already

Made6%

0ther16%

Total Denials FY 2014: 31,451

4

Not Eligible Due to Lookback EarningsBeneficiary Receiving

Cash Benefits44%

Not Eligible for Payment Due to Look Back Earning

13%

Due to VR Ser-vice, Phase 1

Milestone Can't be Paid12%

Earnings Amounts Do Not Meet Crite-

ria for Payment9%

Duplicate Request - Payment Already

Made6%

0ther16%

Total Denials FY 2014: 31,451

Recognize a Prior Earnings Denial

5

18 month Lookback Tool (applies to tickets assigned 07/21/2008 and after)

State Vocational Rehabilitation Agency Services, Phase 1 Not Available Beneficiary

Receiving Cash Benefits

44%

Not Eligible for Payment Due to Look Back Earning

13%

Due to VR Service, Phase 1

Milestone Can't be

Paid12%

Earnings Amounts Do Not Meet Crite-

ria for Payment9%

Duplicate Request - Payment Already

Made6%

0ther16%

Total Denials FY 2014: 31,451 6

Recognizing a Phase 1 Denial due to Successfully Closed Case

• Ask about any prior State VR agency services• Check the Secure Provider Portal• State VR agencies can function as a referral source• This rule only applies to situations where the VR has

submitted a successful closure status dated 2002 or after.

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VR Services, Phase 1 Not Available

• Even if a beneficiary has a history of prior VR services and a successful case closure, the Ticket still has significant value.

• Total value remaining in 2015 after Phase 1 Milestones: o SSI: $18,564.00o SSDI: $19,411.00

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Earnings Amounts Do Not Meet Criteria for Payment Beneficiary

Receiving Cash Benefits

44%

Not Eligible for Payment Due to Look Back Earning

13%

Due to VR Ser-vice, Phase 1

Milestone Can't be Paid12%

Earnings Amounts Do Not Meet Cri-

teria for Payment

9%

Duplicate Request - Payment Already

Made6%

0ther16%

Total Denials FY 2014: 31,451

Avoiding a Denial Due to Earnings Amounts That Do Not Meet Criteria for Payment

Monthly Earnings Estimator10

SSI and SSDI Earnings

Earnings are calculated depending on entitlement program• Supplemental Security Income (SSI)/T16 – Pay date• Social Security Disability Insurance (SSDI)/T2 – earned during

the month, i.e. from the 1st day of month to the last day of the month, regardless of when the beneficiary is actually paid

• Concurrent (SSI and SSDI) – both pay date and pay periods. OSM will use eligible earnings for payment.

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Duplicate Request – Payment Already MadeBeneficiary Receiving

Cash Benefits44%

Not Eligible for Payment Due to Look Back Earning

13%

Due to VR Ser-vice, Phase 1

Milestone Can't be Paid12%

Earnings Amounts Do Not Meet Crite-

ria for Payment9%

Duplicate Request - Payment Already

Made6%

0ther16%

Total Denials FY 2014: 31,451

Duplicate Request

• Multiple Payment Requests

• Universal Auto Pay Already Established

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How to Avoid Denials General Info

• Request previous pay stubs or employer earnings statements as either part of the intake process or once the ticket is assigned. This will give an EN an idea of which, if any, milestones to submit.

• Call the IVR toll free at 866.949.3687 and follow the prompts. You will be able to access previous assignability.

• Check the Secure Provider Portal for VR closure status if previously assigned to a VR.

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Employer Prepared Earnings Statementvs

Supplemental Earnings Statement

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• Do you know what these forms are used for?

• How are they the same or different?

Supplemental Earnings Statement• When to use an Supplemental Earnings Statement form

o Pay stubs are missing required information. o Pay stubs are illegible.

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Employer Prepared Earnings Statement

• When to use an Employer Prepared Earnings Statement formo If you are not able to obtain any earnings documents from the

beneficiary and earnings information is not available via The Work Number.

o You’ve received earnings documentation that are not legible because they have been faxed or copied repeatedly and the beneficiary no longer has the original copy.

o If you have the employer contact information, you can complete and submit this signed form as a source of primary evidence.

o It provides confirmation from the employer that all withholdings were made. (for example, FICA and Medicare withholding taxes.

o These withholdings confirm the beneficiary is not a self-employed individual and the employer is deducting all required withholdings at time of payment.

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Employer Prepared Earnings Statement

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Recap & Summary

• Recognize the most frequent reasons for payment denials• Benefits not suspended or terminated due to work• Not eligible due to look back earnings• VR Services, Phase 1 is not available• Earnings amounts do not meet the criteria for payment• Duplicate Request – Payment Already Made

• Supplemental Earnings Statement vs Employer Prepared Earnings Statement

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New Ticket Portal Top Payments Questions

1. Question: For Phase 1 Milestone 2, Milestone 3 and Milestone 4 payments, three months constitute one payment. Do we have to submit three payment requests for the same payment since we can only type in one month at a time?

Answer: You only need to submit one payment request for each payment (claim). For Phase 1 milestones you will use the attainment (qualifying) month as the month of the payment request. For example, a payment request for Phase 1 Milestone 2 will use the 3rd month the beneficiary had earnings at Trial Work Level, which is the attainment month, as the payment month. This is consistent with the payment month you see in your current payment status report available on the Secure Provider Portal.

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New Ticket Portal Top Payments Questions

2. Will the payments data include payment history from before the transfer to the new Ticket Portal?

Answer: Yes, all payment history will be available via the new Ticket

Portal

3. Question: Does each paystub need to be added separately or can we enter an entire month at once?

Answer: Yes, you will need to enter each pay stub separately. The system will allow you to enter earnings for 5 pay periods when you enter earnings in the ticket portal for each payment request.

However, there is no limit to the number of documents you submit with the fax cover sheet.

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New Ticket Portal Top Payments Questions

4. Question: Using the new portal, do we need to make a request for all payments we wish to receive?

Answer: ENs should submit a separate payment requests for each

claim month and type of payment. For example, if an EN wants to request 3 outcome payments for January thru March 2015, the

ENmust submit a separate payment request for: Claim month

January2015, Type of claim: Outcome; Claim month: February 2015,

Type ofclaim: Outcome; Claim month: March 2015; Type of claim: Outcome.

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Final Q & A and Wrap Up

What questions do you have?

The Next All EN Payments call will be

May 19, 2015 from 3-4pm Eastern Time

Thank you for joining us today!