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Revision 25-1; Effective Feb. 19, 2025
3710 Managed Care Data in the Texas Integrated Eligibility Redesign System
Revision 25-1; Effective Feb. 19, 2025
3711 County Code Issues Affecting Enrollment
Revision 25-1; Effective Feb. 19, 2025
The Service Authorization System Online (SASO) reflects the residence county as recorded in the Texas Integrated Eligibility Redesign System (TIERS). Correction to the county code must be done in TIERS. Program Support Unit (PSU) staff must inform the Medicaid for the Elderly and People with Disabilities (MEPD) specialist by faxing Form H1746-A, MEPD Referral Cover Sheet (PDF), to correct the county code. Incorrect county code records in TIERS can cause enrollment problems for applicants or members in STAR+PLUS.
Supplemental Security Income Cases
TIERS derives the county based on the residential Zoning Improvement Plan (ZIP) code provided by the Social Security Administration (SSA) if an individual receives Supplemental Security Income (SSI). A ZIP code may appear incorrectly in TIERS because of one of the following reasons:
- data entry error; or
- a ZIP code crosses county lines.
Either of these issues can cause TIERS to assign the wrong county.
Non-SSI Cases
TIERS contains the county code entered by the MEPD specialist if the individual has any SSI type program (TP) other than TP 12 or TP 13. The following may be the cause of an individual not having TP 12 or TP 13:
- an individual moves without notifying the MEPD specialist; or
- an MEPD specialist enters an incorrect county code.
What to Do to Resolve Address Issues Affecting Enrollment
- Perform an inquiry in TIERS.
- Identify the TP in TIERS by cross referencing Appendix III, Medicaid Type Program Codes for STAR+PLUS HCBS Program and CFC.
- Refer the matter to the MEPD specialist to correct the residence county field if the TP is anything but 12 or 13 and the residence county is incorrect.
- If the TP is 12 or 13:
- Determine the residence ZIP code recorded in TIERS.
- If the residence ZIP code is not correct, the individual must report the correct ZIP code to SSA.
- PSU staff must email the Data Integrity Unit (DIU) mailbox the following information if the residence ZIP code in TIERS is correct but the county is incorrect:
- individual’s name as recorded in TIERS;
- individual’s Medicaid identification (ID) number;
- residence ZIP code; and
- residence county as it should be reflected in TIERS.
The DIU can update TIERS to correct the error. The correction takes place during the next TIERS cutoff processing, usually around the 20th day of the month. SASO should reflect the corrected county during the first TIERS-to-SASO reconciliation that occurs after TIERS cutoff, usually the day after cutoff.
3712 Service Interruptions Resulting from County Code Mismatches in TIERS
Revision 25-1; Effective Feb. 19, 2025
Participation in managed care programs is based on an individual’s residence county, as recorded in the Texas Integrated Eligibility Redesign System (TIERS). Therefore, service interruptions can occur when the TIERS record shows the wrong residence county code.
The Service Authorization System Online (SASO) reflects the residence county as recorded in TIERS and is updated through a monthly interface. As a result of this, incorrect county code data in SASO must be corrected in TIERS. The manner in which this correction occurs depends on the individual’s type program (TP).
PSU must complete the following activities if a residential county code is incorrect and the individual receives services under:
- Perform an inquiry in TIERS.
- Identify the TP in TIERS by cross referencing Appendix III, Medicaid Type Program Codes for STAR+PLUS HCBS Program and CFC.
- For TP 12 or 13 in TIERS: advise the applicant, member or authorized representative (AR) to contact the Social Security Administration (SSA) to request a correction. The Data Integrity Unit (DIU) can correct problems in TIERS that result from Zoning Improvement Plan (ZIP) codes that cross county lines. In these situations, SSA assigns a default county code in the computer program matrix, which is transferred to TIERS data files. Results of correction requests to the DIU mailbox, take place during the next TIERS cutoff, usually around the 20th day of the month. SASO will reflect the corrected county during the first TIERS-to-SASO reconciliation that occurs after TIERS cutoff, usually the day after cutoff. Describe the needed change in the email and send the following information:
- individual’s name as recorded in TIERS;
- individual’s Medicaid identification (ID) number; and
- correct ZIP code and residence county as it should be reflected in TIERS.
- For TP 03, TP 18, TP 19, TP 21, TP 50, TP 87 or TP 88 in TIERS: fax Form H1746-A, MEPD Referral Cover Sheet (PDF), to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist assigned to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and request a correction.
- For Supplemental Nutrition Assistance Program (SNAP): fax Form H1746-A to the MEPD specialist assigned to the HEART case record and request a correction.
- For TP 12 or 13 in TIERS: advise the applicant, member or authorized representative (AR) to contact the Social Security Administration (SSA) to request a correction. The Data Integrity Unit (DIU) can correct problems in TIERS that result from Zoning Improvement Plan (ZIP) codes that cross county lines. In these situations, SSA assigns a default county code in the computer program matrix, which is transferred to TIERS data files. Results of correction requests to the DIU mailbox, take place during the next TIERS cutoff, usually around the 20th day of the month. SASO will reflect the corrected county during the first TIERS-to-SASO reconciliation that occurs after TIERS cutoff, usually the day after cutoff. Describe the needed change in the email and send the following information: