317:35-5-41.2

For non-SSI recipients:

Verification of resources held in bank accounts or other financial institutions may be established through an Asset Verification System (AVS).

• Money on hand or in a savings account is considered as a countable resource the month after receipt.
• Checking accounts may or may not represent savings. Current bank statements are evaluated with the member to establish what, if any, portion of the account represents savings. Any income which has been deposited during the current month is not considered a resource in the month it is received.
• Documentation should identify the account as belonging to the client.
• Accounts owned jointly with a person not receiving SoonerCare are considered available to the member in their entirety unless it can be established what part of the account actually belongs to each person and the money is separated and the joint account dissolved.
• At review, if customer produces the bank statement prior to the current month, we are able to accept this to verify resource. IE: customer completes MCR on 2/15/24 and produces a bank statement from 12/25/23, it can be used if that is all that the customer has provided. The most recent statement is preferred.

For those receiving SSI –

We currently operate under an SSI criteria state, which means that verification of resources is not required when an applicant is an SSI recipient.

Guidance for non-SSI recipients:

Short-term Medical Applications – During the interview, pull up AVS to see if an initial request has been made. If they are not located, then manually add the request with specific banking information. When a case is placed in application status, the initial request for the client is sent to AVS by the next working day. Please reference and follow First Contact Resolution (FCR) steps/processes. You may also use the client’s provided bank statements or if the client offers, you may elect to conference call with their bank then proceed with case and document based on reliable information received. Mark application as complete, as no further actions are needed.

If reliable information cannot be received, mail ADM-92 requesting verification needed, and pend with a due date of 10 days in Current^TM.

Short-term Medical Reviews – Check AVS. If banking information is available in AVS, please proceed. If banking information is unavailable, please use ad-hoc function in AVS and document in Case Notes. You may use the client’s provided bank statements or if the client offers, you may elect to conference call with their bank then proceed with case and document based on reliable information received. Mark review as complete, as no further actions are needed.

If reliable information is not received:

• If we are unable to verify information after using the data exchange sources, then send an ADM-92 for verification.
• Please be sure to verbally advise the client what verifications are needed while interacting with the client.
• Please pend the case without a due date.
• Please use Web Utility to code the case “More Medical Information Needed” (see screen shot below for reference).  Note, if Web Utility does not recognize the case, please just follow the above guidance and move to the next case.

Long-term Medical Reviews – Follow normal processes.