FAA1.A Background and Introduction : 07 Handling Special Cases - Overview : A Handling Special Cases – DBME Employees
A Handling Special Cases – DBME Employees
 
(01/01/20 - 12/31/20)
The Employee Benefit Unit (EBU) maintains all current Division of Benefits and Medical Eligibility (DBME) employee program case files(g). This includes employees of the following administrations:
 
Disability Determination Service Administration (DDSA)
Family Assistance Administration (FAA)
Quality Management Administration (QMA)
 
An active or inactive FAA program case file of a current DBME employee is locked and can only be accessed by the following:
 
Staff designated by DBME Administration
Human Resources
 
The EBU staff completes all eligibility actions on locked case files. This includes, but is not limited to, the following:
 
Completing the application process (new and renewal).
Processing all changes, including NA Mid Approval Contacts.
Responding to inquiries from employees, contractors, volunteers, and temporary employees.
Completing reports of potential overpayments.
Writing overpayments. (See Overpayments Overview for policies and procedures.)
Accepting and processing appeal hearing requests. (See Appeals Overview for policies and procedures.)
Attending hearings for employees who request an appeal
 
DBME employees must complete the application process for their own case and cases in which they are a representative during nonwork time.
 
EXCEPTION
Designated break time is considered State work time. Only the following activities are allowed during a designated break time:
Taking documents to the an office manager (LOM) or direct supervisor to be uploaded.
NOTE This is not a conflict of interest for the LOM or direct supervisor.
Contacting the EBU using State owned equipment such as emailing, telephone or faxing for any reason other than to complete the eligibility interview.
NOTE Prior to using state owned equipment, a member of office management must be informed.
 
DBME employees must not have any case involvement(g) with their own case or any case that may result in a conflict of interest. This includes, but is not limited to, the following:
 
Accessing, viewing, or making changes to the case file(g)
Determining eligibility of benefits
Registering applications
Interviewing the participant
Case specific discussion with another DBME employee about the employee’s case
Issuing EBT cards on these cases
Submitting verification on behalf of a participant with whom a conflict of interest exists
 
WARNING
All AZTECS, HEAplus, and OnBase(g) inquiries are recorded and monitored. Actions that display on a case for which there may be a conflict of interest could be considered suspicious or potentially fraudulent activity.
 
DBME employees may contact the EBU for information on their own case.
 
When information is needed on their own case file(g) or a case in which they are a representative, an employee may consider accessing one of the following personal accounts during nonwork time:
 
MyFamilyBenefits account
HEAplus account using the customer portal
 
WARNING
DBME employees must not be given special privileges and must be treated as any other participant. State email is not to be used to solicit information regarding their own case.
 
Additional policy and procedures regarding employee case handling are outlined as follows: