Customer Contact Center Food Stamp/Family Medicaid Phase II ...

Call Center FS & FM Phase II PG February 29, 2008
Initial Application
FSME for Margaret Simmons
Margaret is not eligible for a medical expense deduction.
INTERVIEW FOOD STAMP MEDICAL EXPENSES - FSME FSME 01
Month 11 06 01
Client Name MARGARET SIMMONS Client ID 777006064
Del Freq Pro. Num Type Amt V Date TPL Prorated
Of Mths Incurred Amt Amount
Provider Name
Provider Name
Provider Name
Provider Name
Provider Name
Provider Name
Message
More Med Exp
15-lett
24-del
• Documentation Requirement:
• Explanation for not allowing an allowable expense
• Explanation for not allowing Medicare Premium because of buy-in
• Computation or explanation of expenses allowed
PG-22