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C—811 Case Number and Eligibility Determination Group (EDG) Number
Revision 15-4; Effective October 1, 2015
All Programs
A case is defined as a group of persons who are seeking benefits together for at least some, if not all, of the members of the group. Members included on the case may or may not be certified to receive benefits. Each case is identified by a 10-digit case number. A TIERS case can include multiple EDGs. An EDG is defined as members of a household whose needs, resources, income, and deductions, as applicable by program, are considered in determining eligibility for benefits. Each EDG is identified by a nine-digit EDG number.
Example: If a household is approved for Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP), assign one EDG number for TANF and another EDG number for SNAP.
Case numbers are kept indefinitely and should be reassigned when the household reapplies for any program.
Note: There may be instances when a new case number may be required, such as for a person leaving a drug treatment facility or for foster care cases.
Related Policy
Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP), B-475
C—812 Individual Number
Revision 15-4; Effective October 1, 2015
All Programs
The first time a person is approved for Texas Health and Human Services Commission (HHSC) services or benefits, TIERS assigns an individual a unique number. Advisors use the same number, called the individual number, for that person for all programs.
Individual numbers are kept indefinitely and should be reassigned when the individual reapplies for any program.
C—813 Hierarchy of Individual Identification Data
Revision 15-4; Effective October 1, 2015
All Programs
Before approving an applicant who already has an individual number, advisors must compare information in TIERS inquiry to the information in the case record. Advisors should note and clear any discrepancies with the individual.
TIERS retains only one set of identification information for each individual. The advisor must make changes according to the hierarchy. The following priority applies:
- A program area providing benefits to an individual takes precedence over a program area not providing benefits. For example, TANF caretaker information takes precedence over TANF payee information, and an active case takes precedence over a denied case.
- For name and birth date identification data:
| Priority is given to ... | over ... |
|---|---|
| Medical Programs | TANF |
| TANF | Supplemental Security Income (SSI), SNAP, SAS* |
| SNAP | SAS* |
- For sex and race identification data:
| Priority is given to ... | over ... |
|---|---|
| Medical Programs | TANF, SSI, SNAP, SAS* |
| TANF | SSI, SNAP, SAS* |
| SNAP | SSI, SAS* |
| SSI | SAS* |
* SAS is Long Term Care's Service Authorization System. Long Term Care authorizes payments to its service providers using this system.
Note: If the Social Security Administration (SSA) validates the Social Security number (SSN) or claim number, the advisor cannot change the number in TIERS. Document the incorrect SSN in the Request Merge/Separate record, if requesting a merge/separate. Use the existing number on file and report the correct number by memorandum to State Office Data Integrity (SODI) Section, Long Term Care, State Office, Y-922.
Before approving an applicant in another program area, check TIERS for accuracy of identifying information. If the identifying information is incorrect, enter the correct information in the Individual Household Logical Unit of Work (LUW) or other applicable LUW in TIERS.
C—814 Merge and Separate
Revision 14-1; Effective January 1, 2014
All Programs
Advisors use the functional area on the left navigation bar titled Merge/Separate to request a merge or a separate.
Select Request Merge if an individual has been assigned more than one individual number. Follow the steps below.
- Enter a minimum of two and up to 10 individual numbers to be merged. Enter mandatory comments explaining the reason for the merge request.
- Click the Add button. The demographic information associated with that individual number will be displayed in the Selected Individuals section. If it is not the correct person, delete the entry using the Delete icon or use the Binoculars icon to search for the individual using the demographic data, similar to the individual search in Inquiry.
- Once the individual numbers and mandatory comments are entered, click the Submit button to send the request to State Office Data Integrity.
Select Request Separate when more than one person is assigned to a single individual number. Follow the steps below.
- Enter one shared individual number and up to three individual numbers to be separated. Enter mandatory comments explaining the reason for the separate request.
- Enter the individual number or demographic information and click Add. The demographic information associated with the individual number will be displayed in the Selected Shared Individuals and Shared ID above is to be separated to these individuals sections. If it is not the correct person, delete that entry using the Delete icon or use the Binoculars icon to search for the individual using demographic data, similar to the individual search in Inquiry.
- Once all the individual numbers and mandatory comments are entered, click the Submit button to send the request to State Office Data Integrity.
TIERS will not allow a merge or separate request to be submitted for an individual number when a merge or separate request already exists and will display a validation message. When TIERS displays a validation message, correct the information if entered incorrectly or use the Search Merge/Separate to determine if the individual numbers requested are associated with the same individual number.
Use Search Merge/Separate to track the progress of the request. Some requests will take longer than others. Some individual numbers have to age off of an EDG due to the denial effective date. State Office Data Integrity staff can mark an individual number as a Potential Duplicate (PD) when a merge or separate request is made. Staff cannot select an individual number for addition to new cases if it is marked as PD, which limits the potential for the wrong individual number to be awarded benefits or coverage in error.
Questions concerning a merge or separate request should be sent to the State Office Data Integrity mailbox at tiers_statepaidmedicaid@hhsc.state.tx.us.
C—815 TIERS Case Modes
Revision 14-1; Effective January 1, 2014
A TIERS case mode is a particular mode that TIERS uses to determine the sequence of LUWs it presents during Data Collection. The case mode is typically determined by the type of action being taken on the case, for example, Intake (new application), Complete Action (redetermination), Change Action (processing a change), and so on. Staff set the case mode in the Data Collection – Initiate Interview page. Staff should check the case mode prior to starting a case by performing inquiry. Inquiry displays the current case mode and the employee number of the advisor currently assigned the case. The current case mode is also displayed at the top of each page in Data Collection.
C—815.1 Case Mode Definitions
Revision 15-4; Effective October 1, 2015
All Programs
There are 16 case modes.
| Mode | Definition |
|---|---|
|
Case Reading |
Authorized staff use this mode to examine certain information for a case and record results online. |
|
Change Action |
Used to make changes to a case when no application is required. |
|
Complete Action |
Used for redeterminations and reviews or applications for a new program for an individual in an existing case. |
|
Continue Previously Selected Mode |
Allows staff to access Data Collection in the mode previously used. |
|
Conversion |
The case mode that System for Application, Verification, Eligibility, Referrals, and Reports (SAVERR) cases and Children's Health Insurance Program (CHIP) cases were converted to if there was mismatched data. This mode is utilized by authorized staff. |
|
Intake |
Used when the household is requesting assistance for the very first time or for an existing case when all of the EDGs are denied. |
|
Ongoing |
Ongoing mode provides read-only access to all LUWs. Exception: Changes can be made in Ongoing mode to the Household Address – Details page and the Initiate Interview – Initiate Review page. In these two areas, updates can be made without running Eligibility Determination Benefit Calculation (EDBC) and then having to dispose all EDGs. Used with start date and end date fields on the Initiate Interview page to view historical records for a specific time period. |
|
Periodic Income Check (PIC) |
Used when a client returns information requested in a missing information request during a PIC. |
|
Reopen |
Used when an advisor reopens a case (no active EDGs) and it has been more than 30 days since the last denial action. |
|
Reopen-Left Navigation |
Used when the advisor reopens a case (no active EDGs) and it has been 30 days or less since the last denial action. |
|
SSI Certification |
This mode is used by State Office Data Integrity staff to approve SSI Medicaid. |
|
SSI Manual Create |
Allows authorized staff to establish SSI eligibility in TIERS for an individual when the individual is newly eligible for SSI, or when an SSI-eligible individual has moved from another state and the record is not yet available through the TIERS interface with State Data Exchange (SDX). |
|
Second Level Review |
Used when a second level review is required. The staff member must be authorized to perform second level reviews on TIERS cases. |
|
Special Review |
Used when a case or EDG requires a review or reauthorization of services that falls outside the normal redetermination time frames. |
|
Spousal PRA |
Allows authorized staff to record information and determine the Spousal Protected Resource Amount (SPRA) for institutional and waiver programs. |
C—816 Case Mode Hierarchy
Revision 14-1; Effective January 1, 2014
All Programs
Complete Action and Intake modes have hierarchy over all other modes. When an advisor is working on a case in Complete Action or Intake mode, other staff can enter information in TIERS, but they cannot send notices or dispose the case. Their actions are disposed only when the advisor working in Complete Action or Intake mode disposes the case. If an advisor has the case in Change Action mode and subsequently a different advisor accesses the case in Complete Action mode, the Change Action advisor can continue to enter information in the case, but the Complete Action advisor is the only one who can dispose the case and send notices.
Once an advisor accesses a case in Complete Action mode, all individual-initiated changes go to that advisor until the case is disposed. In addition, once an advisor begins an individual-initiated change, all subsequent individual-initiated changes will go to that advisor until the case is disposed. However, outstanding alerts assigned to someone else do not automatically transfer to an advisor who begins a new action on a case.
Note: TIERS routes agency-generated changes based on the office profile.
C—817 Electronic Data Sources (ELDS)
Revision 15-4; Effective October 1, 2015
All Programs
Information from ELDS, such as State Online Query (SOLQ), is presented to advisors in TIERS during Data Collection to allow the advisor to use it as verification. If verification is not available through ELDS in Data Collection, advisors must attempt to verify using other electronic sources (i.e., Data Broker) before requesting additional information or documentation from the applicant.
Advisors must receive written or verbal consent for any adult age 19 or older that is included on an application or renewal and whose information is needed to make an eligibility determination before:
- requesting information from electronic data sources, such as Data Broker or SOLQ; or
- using the individual’s information from TIERS, if that adult has a case with HHSC (SNAP, TANF, Medicaid or CHIP).
When consent is given, advisors may use ELDS, a Data Broker report, and/or information from a known case.
If the advisors cannot obtain consent to use ELDS, Data Broker, or existing HHSC data, advisors must deny the application for the individual whose eligibility is being determined.
SNAP and TANF
The signature of the person submitting the application or renewal provides permission for all household members.
Medical Programs
The signature of the person submitting the application or renewal provides permission for any adult listed in A-121, Receipt of Application. For individuals not listed in A-121, advisors must attempt to contact the individual whose permission is needed by phone or via Form H1213, Children’s Health-Care Benefits: More Facts Needed from the Parent Who Has Custody.
Example: If a non-custodial parent applies on behalf of a child, information, such as income from the custodial parent, may be needed from the custodial parent to determine that child’s eligibility. Advisors must call and obtain verbal consent from the custodial parent before pulling electronic data on that individual, even if the custodial parent’s information is available in the system. If the advisor cannot get consent from the custodial parent, the advisor must request the missing information needed from the custodial parent using Form H1213. If the custodial parent does not provide consent to use electronic data, the advisor must deny the child’s application.
Related Policy
Verification Requirements, A-1370
How to Use Texas Workforce Commission (TWC) Quarterly Wage Information to Budget Earned Income, A-1355.2