RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Process:
This process retrieves the appropriated Daily Issuance Request from the Daily Issuance Transaction Hold
Data Store and based on business rules, issues the benefits to the case. The system shall allow issuance
authorizations that are at or above minimum thresholds based on program policy/rules. The system must
also support the issuance of FS Disaster Benefits.
Sub-Processes:
1. Pull Issuance Request
The system shall retrieve the issuance requests from the Transaction Hold Data Store. This data
store holds all the Issuance Requests that are created by all the on-line transactions through out the
day. The Transaction Hold may contain more than multiple Issuance Requests for each Case,
Program and Sub-Program, and each one can be a separate Issuance.
TRANSACTION HOLD (Input)
Case Number
Program
Sub-Program
County Number
Employment Number
Record Type Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Caseload Number
Approval Required Switch
Actual Approval Code
User ID
Issue Method Code
Offset Amount
Segment Date
Overpayment Begin Date
Overpayment End Date
Alert Supervisor User ID
Benefit Request Type Code
Benefit Reason Code
Request Amount
Benefit Month
Patient Medical Liability Amount
Replacement Benefit Date
Replacement Benefit Number
Eligibility Begin Date
Eligibility End Date
Medical Only Switch
Individual Unique Identifier Number
Warrant Switch
Case Number Claim
Category Claim
Sequence Number Claim
Claim Number
Food Stamp Benefit Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Offset Amount Applied
Claim Switch
2. Determine Supervisory Approval Required
The system shall determine if a supervisor’s approval is required by checking the Approval Required
Switch.
TRANSACTION HOLD (Input)
Approval Required Switch
3. Determine If Approved
If approval is required, the system shall evaluate Actual Approved Code to determine if the request
has been approved.
TRANSACTION HOLD (Input)
Actual Approval Code
4. Generate Alert
If the system determines that the Issue Request requires supervisory approval, but the request has
not been approved, the system shall generate a Supervisor Alert.
TRANSACTION HOLD (Input)
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Case Number
Program
Sub-Program
County Number
Employment Number
Record Type Code
Caseload Number
Approval Required Switch
Actual Approval Code
User ID
Issue Method Code
Offset Amount
Segment Date
Overpayment Begin Date
Overpayment End Date
Alert Supervisor User ID
Benefit Request Type Code
Benefit Reason Code
Request Amount
Benefit Month
Patient Medical Liability Amount
Replacement Benefit Date
Replacement Benefit Number
Eligibility Begin Date
Eligibility End Date
Medical Only Switch
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Individual Unique Identifier Number
Warrant Switch
Case Number Claim
Category Claim
Sequence Number Claim
Claim Number
Food Stamp Benefit Number
Offset Amount Applied
Claim Switch
5. Determine if Issuance for Today
The system shall determine if the issuance is for today by comparing the transaction Benefit Month
date to the System Date. This is only done for RM, RR and EX Benefit Types. All other Benefit
Types bypass this test and are automatically selected for today.
TRANSACTION HOLD (Input)
Benefit Month Date
6. Extract Data for Issuance
The system shall use the issuance request and extract additional data to build an issuance
transaction.
TRANSACTION HOLD (Input)
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Case Number
Program
Sub-Program
County Number
Employment Number
Record Type Code
Caseload Number
Approval Required Switch
Actual Approval Code
User ID
Issue Method Code
Offset Amount
Segment Date
Overpayment Begin Date
Overpayment End Date
Alert Supervisor User ID
Benefit Request Type Code
Benefit Reason Code
Request Amount
Benefit Month
Patient Medical Liability Amount
Replacement Benefit Date
Replacement Benefit Number
Eligibility Begin Date
Eligibility End Date
Medical Only Switch
Individual Unique Identifier Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Warrant Switch
Case Number Claim
Category Claim
Sequence Number Claim
Claim Number
Food Stamp Benefit Number
Offset Amount Applied
Claim Switch
CASE (Input)
Case Number
Case Record Date
Case Status Code
Case Name
Case Caseload Number
Case Living Arrangement Code
Case Phone Number
Case Closed ELIG For Benefit Switch
Case Primary Information Person Household Switch
Case PIP Verify Code
Case Residence Address Line 1 Street Number
Case Residence Address Line 1 Unit
Case Residence Address Line 1 Direction
Case Residence Address Line 1 Rural
Case Residence Address Line 1 Suffix
Case Residence Address Line 1 Quadrant
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Case Residence Address Line 1 Apartment
Case Residence Address Line 2
Case Residence Address City
Case Residence Address State
Case Residence Address Zip
Case Expedite FS Switch
Case Homeless Switch
Case History Code
Case Program Code
Case Sub-Program Code
Case Sanction Reason Code
Case Date Sanction Begins
Case Date Sanction Ends
Case Worker ID Authorizing Case
Case Date Delayed Spenddown liability for Medicaid Met
Case Eligibility Begin Date
Case Eligibility End Date
Case Date Retroactive Period Begins
Case Date Retroactive Period Ends
Case Date Application Signed
Case Recoupment Switch
Case Fair hearing Status switch
Case Authorized Rep Switch
Case Protective Payee Switch
Case Mail Address Switch
Case Issuance Method code
Case Effective Benefit Amount after End of Month
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Case Net Change Amount to Benefits Due to Adverse Action
Case Status Reason Codes 1
Case Fiat Switch
Case Date Case Authorized
Case FF Child Support Sanction Switch
Case Work Related Sanction Code
Case Voluntary Quit Sanction Switch
Case Parental Striker Sanction Switch
Case Work Related FS Action Code
Case Voluntary Quit FS Action Code
Case 20 Percent Penalty Code
Case Adverse Action Switch
Case Tape Payment Standard Code
Case Immunization Sanction Switch
Case Health Checks Sanction Switch
Case School Attendance Sanction Switch
Case Unmarried Minors Not Attending School Disqualification Switch
Case Funding Stream Code
Case Funding Stream Effective Date
Case Extended Services Switch
INDIVIDUAL (Input)
Unique Identifier Number
Status Code
Social Security Number
Last Name
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
First Name
Middle Initial
Date Of Birth
Phone Number
Pregnancy Verification Code
Individual Identification Verification Code
Living Arrangement Code
Social Security Applied Verification
Living Arrangement Date
Resident of State Switch
SS5 Date
Citizenship
Ethnicity
Race
Emancipated Minor Indicator
Veteran Status
Marital Status
Migrant Worker Information
Gender
Good Cause Claimed Indicator
Good Cause Granted Indicator
Medical Provider Name
Pregnancy Switch
Pregnancy Due Date
Date Pregnancy End
Date Pregnancy Begin
Post Partum/New Born Extended Coverage Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Department of Health and Employment Code
Birth Verification
DH Interface Program Switch
TennCare Managed Care Organization Number
MCO Transmit Code
Language Code
Principal Wage Earner Switch
Current FF Cycle Count
Lifetime FF Cycle Count
FF Sanction
TCS Application Switch
ME Application Switch
TennCare Application Date
Color Approved Code
TNCARE Appeal Code
TNCARE Re-verification Code
Insurance Policy Number
Monthly Cost of Coverage Amount
Coverage Code (occurs 15 times)
Coverage Verified Code
Medical Support Coverage Switch
Co-operative with Medical Support Switch
Begin Date for Policy Coverage to Apply
Date Policy Begins to Applies
Date Policy No Longer Applies
End Date for the Policy Cost Applying
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
BUDGET (Input)
Common Budget Data for FF, FS, MA
Budget Type Code
Benefit Amount
Budget Month Type Code
Date Program Right to Appeal Ends
Number of Eligible Adults
Number of Eligible Children
Total Gross Income
Initial Benefit Amount
Initial Benefit Code
Initial Benefit Date
Dependent Child Disregard Amount
Total Unearned Income Amount
Total Earned Income Amount
Earned Income Deduction Amount
Record Date
Status Code
Time Updated
Common Budget Data for FF, FS
Monthly Recoupment Amount
FF Budgets Data
Initial Benefit Issuance Amount (occurs 6 times)
Sponsored Child Care Disregard Amount
100% Deemed Income Disregard Amount
Amount of Income Deemed to Program/Sub-Program
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Countable Earned Income Amount
Excess Income Amount
Standard Need Amount
Special Monthly Allowance Amount
Net FF Benefit Amount After Deduction of Child Support Received
Date Child Support Was Assigned to DHS
100% Need Standard Test Disregard Amount
Student Earned Income Amount
185% Need Standard Amount
100% of Program Countable Earned Income
Number of Eligible Individuals When Program Fails Financial Eligibility
Number of Eligible Children When Program Fails Financial Eligibility
Amount of Adverse Action Net Change
Amount of Countable Needs Standard
Student Earned Income Amount used in 100% Need Standard Calculation
Sponsor Disregard Income Amount
100% Deemed Income Disregard For a Deemed Sponsor
130% Deemed Income Disregard For a Deemed Sponsor
Number of Deemed Sponsors in the FF/MA Program
Amount of Deemed Sponsor Income for FF/MA Program
Amount of Deemed Sponsor Income for FS Program
Number of Deemed Spouse Count Need in Program Determining 185% - 100% Need Standard
Amount of Unemployment Compensation Received Principal Wage Earner
End Date Of Initial Prorating Period
Unmet Need Amount
Sponsored Child Care Disregard Amount
Monthly Deficit Amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Initial Penalty Amount Used in Budget
Recurring Penalty Amount Used in Budgets (Occurs 6 times)
Standard Need Amount for the Intact Program
Number in Family Cap
FS Budget Data
Shelter/Utility Deduction Amount
Allowable Monthly Shelter Expense Amount
Allowable Monthly Medical Expense Amount
Self-employed Farmer Gross Income Amount
Non-Farm Self-Employment Income Amount
Amount of Income Lost Due to Farm Expenses Exceeding Farm Income
Maximum Net Income Allowable for the FS Program Size
Adjusted Monthly Net Income Amount
Monthly Thrifty Food Plan Amount for Program of this size
Number of Deemed Persons Who Reside with Elderly/Disabled Persons
Program Member Has Been Approved for Disability
Program Member is Unable to Purchase Food and prepare Meals Switch
Educational Financial Aid Income Amount
Standard Monthly Deduction Amount
Standard Monthly Medical Deduction Amount
Over 59 Age Switch
Actual Utility Amount or Utility Standard Amount
Non-Farm Self-Employment Expense Amount
Additional Employment Earned Income Amount
Self-employed Farmer Expense Amount
165% Deemed Income Amount Available to Program
Adverse Action Net Change in Benefits Amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
165% Need Standard for Program This Size
FS Public Assistance Type Code
130% Need Standard amount for program of This Size
Deemed Sponsor Income Disregard Amount
100% Deemed Income Disregard Amount for Deemed Sponsor
130% Deemed Income Disregard Amount for Deemed Sponsor
Number of Deemed Sponsors in the FF/MA Program
Sponsor’s Income Amount After Deductions Deemed to Sponsored Members FF/MA Program
Sponsor’s Income Amount After Deductions Deemed to Sponsored Members FS Program
Number of Deemed Sponsors on FF/MA Program
Deemed Sponsor’s Child Care Disregard Amount
Budget Amount Program Entitled
Intentional Program Violation Recoupment Amount
Administrative Error Recoupment Amount
Inadvertent Household Error Recoupment Amount
Child Support Disregard Amount
Initial 20% Penalty Amount
20% Penalty Amount
Date Penalty Begins
MA Budget Data
Allocated Spouse Amount
Half Remaining Disregard Amount
COLA Disregard Amount
Remaining Unearned Income Disregard Amount
Amount of Past Medical Expenses
Amount of Recurring Medical Expenses
Blind Work Expense Amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Deemed Income Amount
Employment Earned Income Amount
Long Term Care Rate Amount
Gross Unearned Income Amount
Categorically Needy Need Standard Amount
Medically Needy Need Standard Amount
Adverse Action Net Change Amount
Standard Maintenance Amount
Insurance Premium Expense Amount
Spenddown Delay Liability Amount
Personal Need Amount
Patient Liability Amount
Other Deduction Amount for Pickle/Passalong
Ineligible Children Disregard Amount
VA Aid/Attendance Amount
Number of Eligible Adults
Child Support Disregard Amount
Work Disregard Amount
Shelter Workshop Maximum Amount
Student Earned Income Amount
Paid Medical Expense Amount
Spenddown Code
Gross Self-employment Income Amount
Allocated Dependent Amount
Item-D Medical Expense Amount
Patient Liability Expense Amount
Utility Cost Amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Standard Maintenance Amount Percentage
Excess Income Amount
Special Income level Budget Standard Amount
Social Security Income Amount
Long Term Care Facilities Expense Amount
Allocated Dependent/Spouse Amount
Countable Earned Income Amount
Date Child Support Assigned to DHS
MEDICAL PROVIDER (Input)
History Code
Sequence Number
Status Code
Segment Date
Address line 1
Address line 2
Address City
Address State
Address Zip
Provider Name
Type of Medicaid Coverage Code
Delete Code
SELECTED CASE ISSUANCE INFORMATION (Output)
Record Type
Case Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Program Code Food Stamp
Sub-Program Code Food Stamp
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Print Sequence Number
System Origin Code
Fiat Switch
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Fiat Amount
Benefit Issued Amount before Fiat Amount Applied
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash and FS Data
Number of Adults
Number of Child
Voucher Number
Benefit Number
Benefit Issued Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Project Center Number
Vendor Code
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Medicaid Eligibility End Date
Medicaid Card Number
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
Replacement Medicaid Card Number
Replacement Medicaid Care Date
Replacement Medicaid Card Worker Number
Medicaid Spenddown Verification Code
Medicaid Spenddown Amount
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
Benefit Period Amount
AUX Reason Code
Replacement Warrant Number
Replacement Warrant Date
Replacement Worker Number
FF Count Switch Table (occurs 12 times)
FF Countable Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Vendor Unit Number
7. Determine if Issuance for Program FF or MA
The system shall determine if issuance is for FF or MA Program by using the Program Code.
SELECTED CASE ISSUANCE INFORMATION (Input)
Record Type
Case Number
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Program Code Food Stamp
Sub-Program Code Food Stamp
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Print Sequence Number
System Origin Code
Fiat Switch
Fiat Amount
Benefit Issued Amount before Fiat Amount Applied
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash and FS Data
Number of Adults
Number of Child
Voucher Number
Benefit Number
Benefit Issued Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Project Center Number
Vendor Code
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
Medicaid Card Number
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
Replacement Medicaid Card Number
Replacement Medicaid Care Date
Replacement Medicaid Card Worker Number
Medicaid Spenddown Verification Code
Medicaid Spenddown Amount
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Benefit Period Amount
AUX Reason Code
Replacement Warrant Number
Replacement Warrant Date
Replacement Worker Number
FF Count Switch Table (occurs 12 times)
FF Countable Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
Vendor Unit Number
8. Determine if Issuance for Program FF
The system shall determine if issuance is for FF Program to separate the issuance for the FF
Program from the issuance for the MA Program.
SELECTED CASE ISSUANCE INFORMATION (Input)
Record Type
Case Number
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Program Code Food Stamp
Sub-Program Code Food Stamp
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Print Sequence Number
System Origin Code
Fiat Switch
Fiat Amount
Benefit Issued Amount before Fiat Amount Applied
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash and FS Data
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Number of Adults
Number of Child
Voucher Number
Benefit Number
Benefit Issued Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Project Center Number
Vendor Code
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
Medicaid Card Number
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Provider Address State
Provider Address Zip
Replacement Medicaid Card Number
Replacement Medicaid Care Date
Replacement Medicaid Card Worker Number
Medicaid Spenddown Verification Code
Medicaid Spenddown Amount
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
Benefit Period Amount
AUX Reason Code
Replacement Warrant Number
Replacement Warrant Date
Replacement Worker Number
FF Count Switch Table (occurs 12 times)
FF Countable Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
Vendor Unit Number
9. Perform “Add/Modify EBT Case” Process
The system shall perform Add/Modify EBT case. This process will determine if an EBT case needs to
be created and if so, it will create a new EBT Case.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
10. Create MA Eligibility Data for TennCare
The system shall use the MA Issuance to create the MA Eligibility Data which is sent to TennCare.
The MA Issuance has the same data elements as FF&MA Issuance Data Store.
MA ISSUANCE (Output)
Record Type
Benefit Type
Case Number
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
Payee ID Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash Data
Number of Adults Cash
Number of Child Cash
Warrant Number
Warrant Amount
Recoupment Amount
Benefit Amount Cash
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
Benefit Period Amount
AUX Reason Code
FF Count Switch Table (occurs 12 times)
11. Combine Issuance Records for same Case, Program and Sub-Program
The system shall combine the issuance records for same Case, Program and Sub-Program and write
the records to the FF&MA Issuance Data Store.
FF&MA ISSUANCE (Input)
Record Type
Benefit Type
Case Number
Program Code cash
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash Data
Number of Adults Cash
Number of Child Cash
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Warrant Number
Warrant Amount
Recoupment Amount
Benefit Amount Cash
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Benefit Period Amount
AUX Reason Code
FF Count Switch Table (occurs 12 times)
FF&MA ISSUANCE (Output)
Record Type
Benefit Type
Case Number
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Address Line2
Payee City
Payee State
Payee Zip
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash Data
Number of Adults Cash
Number of Child Cash
Warrant Number
Warrant Amount
Recoupment Amount
Benefit Amount Cash
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
Benefit Period Amount
AUX Reason Code
FF Count Switch Table (occurs 12 times)
12. Assign Benefit Numbers
The system shall assign benefit numbers for the FF and MA issuance and produce the necessary
data stores.
FF&MA ISSUANCE (Input)
Record Type
Benefit Type
Case Number
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Sub-Program Medicaid
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash Data
Number of Adults Cash
Number of Child Cash
Warrant Number
Warrant Amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Recoupment Amount
Benefit Amount Cash
Supplement Amount
FF Countable Code
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
AUX CASH DATA
AUX Cash Number of Months
Amount Reason Table (occurs 12 times)
Benefit Period Date
Benefit Period Amount
AUX Reason Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
FF Count Switch Table (occurs 12 times)
FF ISSUANCE (Output)
Same Data Elements as FF&MA ISSUANCE.
FF NON-PAY ISSUANCE (Output)
Same Data Elements as FF&MA ISSUANCE.
ISSUANCE FOR EBT (Output)
Record Type
Benefit Type
Issuance Method
Case Number
FS Cycle Indicator
Program Code
Sub-Program Code
Processed Date
Benefit Date
County Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
EBT Benefit Availability Date
Number of Adults Cash
Number of Child Cash
Benefit Number
Authorized Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Penalty Amount
Case Name
MA ISSUANCE (Output)
Same Data Elements as FF&MA ISSUANCE.
MA NON-PAY ISSUANCE (Output)
Same Data Elements as FF&MA ISSUANCE.
MEDICAL RECONCILIATION (Output)
Case
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Program
Sub-Program
Source Record Code
County
Case First Name
Case Middle Initial
Case Last Name
Case Mail Address Line 1
Case Mail Address Line 2
Case Mail Address City
Case Mail Address State
Case Mail Address Zip
Payee Indicator
Payee Last Name
Payee First Name
Payee Middle Initial
Benefit Type
Creation Date
Card Issue Date
Number of Trailers
Table of Individuals (24 Entries)
Unique Identifier of Individual
Last Name of Individual
First Name of Individual
Middle Initial of Individual
Data Of Birth of Individual
Gender of Individual
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Medicaid QMB Start Date of Individual
Medicaid QMB End Date of Individual
Card Type of Individual
13. Determine If FS Program Issuance
The system shall determine if the issuance is for FS Program by using the Program Code.
SELECTED CASE ISSUANCE INFORMATION (Input)
Record Type
Case Number
Program Code cash
Sub-Program Code Cash
Program Code Medicaid
Sub-Program Medicaid
Program Code Food Stamp
Sub-Program Code Food Stamp
Processed Date
Benefit Date
Benefit Mailed Date
Benefit Reason Code
Living Arrangement Code
District Code
County Code
ADMIN Unit Code
Worker Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
Print Sequence Number
System Origin Code
Fiat Switch
Fiat Amount
Benefit Issued Amount before Fiat Amount Applied
Number of Individuals
Issuance Method Code
EBT Cash Availability Date
Cash and FS Data
Number of Adults
Number of Child
Voucher Number
Benefit Number
Benefit Issued Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Benefit Switch System
Benefit Amount System
Penalty Amount
Deficit Amount
Unmet Needs Amount
Case Name
Project Center Number
Vendor Code
Medicaid Data
Medicaid Number of Adults
Medicaid Number of Children
Medicaid Eligibility Begin Date
Medicaid Eligibility End Date
Medicaid Card Number
Provider Name
Provider Address Line1
Provider Address Line2
Provider Address City
Provider Address State
Provider Address Zip
Replacement Medicaid Card Number
Replacement Medicaid Care Date
Replacement Medicaid Card Worker Number
Medicaid Spenddown Verification Code
Medicaid Spenddown Amount
AUX CASH DATA
AUX Cash Number of Months
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Amount Reason Table (occurs 12 times)
Benefit Period Date
Benefit Period Amount
AUX Reason Code
Replacement Warrant Number
Replacement Warrant Date
Replacement Worker Number
FF Count Switch Table (occurs 12 times)
FF Countable Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
Vendor Unit Number
14. Perform “FS Benefit Reduction Hierarchy” Process
The system shall perform FS Benefit Reduction Hierarchy Process.
15. Perform “Add/Modify EBT Case” Process
The system shall perform Add/Modify EBT Case to determine and possibly create an EBT case to
which this issuance should be posted.
16. Assign Benefit Numbers
The system shall assign benefit numbers to the FS Issuance.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
FS ISSUANCE (Input)
Record Type
Benefit Type
Cycle Indicator
Case Number
Program
Sub-Program
Vendor Code
Project Center Number
Method of Issuance
Processed Date
Benefit Date
Benefit Number
Benefit Reason Code
District Code
County Code
Administrative Unit
Administrative Satellite Number
Unit Code
Worker Number
Payee Code
Payee Name
Payee Unique Identifier Number
Payee Social Security Number
Payee Address Code
Payee Address Line 1
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Address Line 2
Payee Address City
Payee Address State
Payee Address Zip
Number of Adults
Number of Children
Benefit Amount
Authorized Amount
Recoupment Amount
Payee Received Code
Payee Received Name
Date Eligibility Begin
Date Eligibility End
Date Pickup Allowed Begin
Date Pickup Allowed End
Redirect Type Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
Vendor Unit Number
Partition Code
EBT FS Availability Date
Number of Months
Table of Reason Amount (Occurs 12)
Benefit Period
Reason Code
FS Penalty Amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
FS EBT Benefit Amount
FS EBT Authorized Amount
FS ISSUANCE (Output)
Record Type
Benefit Type
Cycle Indicator
Case Number
Program
Sub-Program
Vendor Code
Project Center Number
Method of Issuance
Processed Date
Benefit Date
Benefit Number
Benefit Reason Code
District Code
County Code
Administrative Unit
Administrative Satellite Number
Unit Code
Worker Number
Payee Code
Payee Name
Payee Unique Identifier Number
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Social Security Number
Payee Address Code
Payee Address Line 1
Payee Address Line 2
Payee Address City
Payee Address State
Payee Address Zip
Number of Adults
Number of Children
Benefit Amount
Authorized Amount
Recoupment Amount
Payee Received Code
Payee Received Name
Date Eligibility Begin
Date Eligibility End
Date Pickup Allowed Begin
Date Pickup Allowed End
Redirect Type Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
Vendor Unit Number
Partition Code
EBT FS Availability Date
Number of Months
Table of Reason Amount (Occurs 12)
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Benefit Period
Reason Code
FS Penalty Amount
FS EBT Benefit Amount
FS EBT Authorized Amount
FS NON-PAY ISSUANCE (Output)
Data Elements are the same as FS ISSUANCE.
ISSUANCE FOR EBT (Output)
Record Type
Benefit Type
Issuance Method
Case Number
FS Cycle Indicator
Program Code
Sub-Program Code
Processed Date
Benefit Date
County Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
EBT Benefit Availability Date
Number of Adults Cash
Number of Child Cash
Benefit Number
Authorized Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Penalty Amount
Case Name
17. Increment FF Counters
Based on the business rules, the system shall increment the FF Counters.
FF ISSUANCE (Input)
Same Data Elements as FF&MA ISSUANCE.
INDIVIDUAL (Output)
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Current Counter
Lifetime Counter
18. Post FF Issuance
The system shall post the FF Issuance to the Issuance History Data Store.
FF ISSUANCE (Input)
Same Data Elements as FF&MA ISSUANCE.
FF NON-PAY ISSUANCE (Input)
Same Data Elements as FF&MA ISSUANCE.
ISSUANCE HISTORY (Output)
Type Record
Type Code
Case Number
Program Code
Sub-Program Code
County Number
Benefit Record
Common Data – FF,FS,MA
Benefit Number
Benefit Type
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
County Number
Disposition Status
Disposition Status Date
Individual Unique Identifier
Issuance Status
Issuance Status Date
Number of Adults
Number of Children
Payee Name
Process Date
Type of Payee
Worker Number
Common Data – FF, FS
Benefit Amount
Benefit Date
Benefit Issued Amount
Deficit Amount
Issuance Method Code
Penalty Amount
Recoupment Amount
Unmet Needs Amount
FF Data
Benefit System Switch
Fiche Number
Investigation Status
Investigation Status Date
MA Data
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Benefit Reason
Eligibility Begin Date
Invest Status Code
Invest Status Date
Living Arrangement Code
Warrant Switch
Detail Record
Benefit Reason
Benefit Period
Detail Benefit Amount
FF Countable Code
SFFF Countable Code
System Benefit Amount
SFFF Internal Countable
19. Perform “EBT Authorization for EBT Vendor” Process
ISSUANCE FOR EBT (Input)
Record Type
Benefit Type
Issuance Method
Case Number
FS Cycle Indicator
Program Code
Sub-Program Code
Processed Date
Benefit Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
County Code
Worker Number
Payee Code
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
EBT Benefit Availability Date
Number of Adults Cash
Number of Child Cash
Benefit Number
Authorized Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Penalty Amount
Case Name
20. Print FF Journal
The system shall print a FF Journal and put on Report Viewing Utility.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
21. Post FS Issuance
The system shall post the FS Issuance to Issuance History Data Store.
FS ISSUANCE (Input)
Record Type
Benefit Type
Cycle Indicator
Case Number
Program
Sub-Program
Vendor Code
Project Center Number
Method of Issuance
Processed Date
Benefit Date
Benefit Number
Benefit Reason Code
District Code
County Code
Administrative Unit
Administrative Satellite Number
Unit Code
Worker Number
Payee Code
Payee Name
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Unique Identifier Number
Payee Social Security Number
Payee Address Code
Payee Address Line 1
Payee Address Line 2
Payee Address City
Payee Address State
Payee Address Zip
Number of Adults
Number of Children
Benefit Amount
Authorized Amount
Recoupment Amount
Payee Received Code
Payee Received Name
Date Eligibility Begin
Date Eligibility End
Date Pickup Allowed Begin
Date Pickup Allowed End
Redirect Type Code
Vendor County Number
Vendor Administration Number
Vendor satellite Number
Vendor Unit Number
Partition Code
EBT FS Availability Date
Number of Months
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Table of Reason Amount (Occurs 12)
Benefit Period
Reason Code
FS Penalty Amount
FS EBT Benefit Amount
FS EBT Authorized Amount
FS NON-PAY ISSUANCE (Input)
Data Elements are the same as FS ISSUANCE.
ISSUANCE HISTORY (Output)
Type Record
Type Code
Case Number
Program Code
Sub-Program Code
County Number
Benefit Record
Common Data – FF,FS,MA
Benefit Number
Benefit Type
County Number
Disposition Status
Disposition Status Date
Individual Unique Identifier
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Issuance Status
Issuance Status Date
Number of Adults
Number of Children
Payee Name
Process Date
Type of Payee
Worker Number
Common Data – FF, FS
Benefit Amount
Benefit Date
Benefit Issued Amount
Deficit Amount
Issuance Method Code
Penalty Amount
Recoupment Amount
Unmet Needs Amount
FF Data
Benefit System Switch
Fiche Number
Investigation Status
Investigation Status Date
MA Data
Benefit Reason
Eligibility Begin Date
Invest Status Code
Invest Status Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Living Arrangement Code
Warrant Switch
Detail Record
Benefit Reason
Benefit Period
Detail Benefit Amount
FF Countable Code
SFFF Countable Code
System Benefit Amount
SFFF Internal Countable
22. Perform EBT Authorization for EBT Vendor
ISSUANCE FOR EBT (Input)
Record Type
Benefit Type
Issuance Method
Case Number
FS Cycle Indicator
Program Code
Sub-Program Code
Processed Date
Benefit Date
County Code
Worker Number
Payee Code
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Payee Name
Payee ID Number
Address Code
Payee Address Line1
Payee Address Line2
Payee City
Payee State
Payee Zip
EBT Benefit Availability Date
Number of Adults Cash
Number of Child Cash
Benefit Number
Authorized Amount
Recoupment Amount
Benefit Amount
Supplement Amount
FF Countable Code
Penalty Amount
Case Name
23. Print FS Journal
The system shall print a FS Journal and put on Report Viewing Utility.
24. Post MA Issuance
The system shall post the MA Issuance to the Issuance History Data Store.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
MA ISSUANCE (Input)
Same Data Elements as FF&MA ISSUANCE
MA NON-PAY ISSUANCE (Input)
Same Data Elements as FF&MA ISSUANCE
ISSUANCE HISTORY (Output)
Type Record
Type Code
Case Number
Program Code
Sub-Program Code
County Number
Benefit Record
Common Data – FF,FS,MA
Benefit Number
Benefit Type
County Number
Disposition Status
Disposition Status Date
Individual Unique Identifier
Issuance Status
Issuance Status Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Number of Adults
Number of Children
Payee Name
Process Date
Type of Payee
Worker Number
Common Data – FF, FS
Benefit Amount
Benefit Date
Benefit Issued Amount
Deficit Amount
Issuance Method Code
Penalty Amount
Recoupment Amount
Unmet Needs Amount
FF Data
Benefit System Switch
Fiche Number
Investigation Status
Investigation Status Date
MA Data
Benefit Reason
Eligibility Begin Date
Invest Status Code
Invest Status Date
Living Arrangement Code
Warrant Switch
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Detail Record
Benefit Reason
Benefit Period
Detail Benefit Amount
FF Countable Code
SFFF Countable Code
System Benefit Amount
SFFF Internal Countable
25. Transmit Medical Reconciliation
The system shall transmit the Medical Reconciliation to the Department of Health.
MEDICAL RECONCILIATION (Input)
Case
Program
Sub-Program
Source Record Code
County
Case First Name
Case Middle Initial
Case Last Name
Case Mail Address Line 1
Case Mail Address Line 2
Case Mail Address City
Case Mail Address State
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy/Systems
Date: January 31, 2005
Process: 3.1.14 Daily Issuance
Program Affected: FF, FS, MA Users: The System
Case Mail Address Zip
Payee Indicator
Payee Last Name
Payee First Name
Payee Middle Initial
Benefit Type
Creation Date
Card Issue Date
Number of Trailers
Table of Individuals (24 Entries)
Unique Identifier of Individual
Last Name of Individual
First Name of Individual
Middle Initial of Individual
Data Of Birth of Individual
Gender of Individual
Medicaid QMB Start Date of Individual
Medicaid QMB End Date of Individual
Card Type of Individual
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
Program Rule
Type Number Rule
ALL 1 If supervisor approval is required, the approval required switch contains a yes.
ALL 2 If the supervisor has approved the issuance request, the approval required switch contains a yes and the
actual approval code contains a yes.
ALL 3 Any issuance request requiring approval and is not approved, will be skipped, but a supervisor alert is
issued.
ALL 4 The program code will indicate whether the issuance is for FF, FS or MA program.
ALL 5 Before the benefit number is assigned to an issuance, issuance request can be combined to form one
issuance to be sent to the client. The issuance has to be for the same benefit type, case, program, sub-
program and same issuance date.
ALL 6 The combined issuance gets the benefit number, not each individual issuance that makes up the
combined issuance.
ALL 7 When a daily issuance request is put in the issuance transaction collection data store (which is being
called Transaction Hold Data Store) by the on-line transaction, all decisions about the issuance have
been made by the on-line transactions.
ALL 8 The daily issuance process selects the issuance request for today, and extracts the additional information
from several data stores to create the issuance to be processed.
ALL 9 The system shall generate issuance and non-issuance data stores for reporting purposes.
FF, FS 10 Each issuance request, that is on the Transaction Hold Data Store and requires approval, will be held on
the Transaction Hold Data Store until the approval has been provided.
FF, FS 11 The Add/Modify EBT Case process will determine if an EBT Case has to be generated and added to the
EBT Vendor’s Database.
FF, FS 12 The system shall generate an issuance for EBT where the Issued Amount is greater than zero.
FF 13 The current and lifetime FF Counters will be incremented by each FF issuance for a given benefit month
in which client receives a FF Benefit unless the client FF interrupt code is set on.
MA 14 When creating the DH Eligibility data, the program signed date becomes the Application date.
MA 15 When creating the DH Eligibility data, the Physical Limit Code is updated if the individual is Aged, Blind or
Disabled.
MA 16 When creating the DH Eligibility data, if the program/program-sub is MA M or MAMP, the QMB/SLMB
Begin Date is equal to the Medicaid Eligibility Begin Date and the QMB/SLMB End Date is equal to the
Medicaid Eligibility End Date.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
3.1.14
Daily Issuance
Daily Issuance
Pull Issuance
Request
Request
Transactions
Transaction
Hold
Determine if
Determine if
Supervisor Required? Yes
Approved
approval required
Transaction
Alert
Hold
No
Determine if
Transaction
Issuance for Yes Approved? No Generate Alert
Hold
Today
STOP
Issuance for
No STOP
Today?
Selected Case
Issuance
Yes
Information
Transaction
Budget
Hold
Extract Data for
Issuance
Medical
Case
Provider
Individual
A
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
3.1.14
Daily Issuance
Continued
A
Determine if Perform Add/
Determine if
Issuance for MA or FF? Yes FF? Yes Modify EBT
Program FF
Program FF or MA Case
FF&MA
FF Issuance
Issuance
No
Selected Case No
Issuance FF Non-Pay
Information Create MA Combine Issuance Assign Benefit Issuance
Eligibility Data for same case numbers and
Selected Case
Determine if Store for program, sub- produce necessary
Issuance Issuance for
Program FS TennCare program Data Stores
Information EBT
MA Issuance
MA Issuance
TennCare
Medical
M Recon
FF Reconciliation
FF Issuance
MA
MA Non-Pay
Perform FS Issuance
Perform Add/
Benefit
FS? Yes Modify EBT
Reduction
Case E
Hierarchy
B
No C
FS Issuance
Assign Benefit
numbers and D
STOP produce necessary
FS Non-Pay Data Stores
Issuance
Issuance for
EBT
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
3.1.14
Daily Issuance
Continued Issuance
History
Perform EBT
D Authorization
B Increment FF Post FS Issuance Print FS Journal
Individual for EBT
Counters
Vender
FF Issuance
FS Non-Pay
FS Issuance
Issuance
STOP
FF non-pay
Post FF Issuance
Issuance
Issuance
History
MA Non-Pay
MA Issuance
Perform EBT Issuance
Authorization
for EBT
Vender
C Post MA Issuance STOP
Print FF Journal
Issuance
History
Medical
STOP Reconciliation
E Transmit Medical
DOH
Recon