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Free-form text for ACES letters
Purpose: To describe the free-form text requirements for the Apple Health ACES Letters listed below.
Letter | Letter Title | Freeform Text Requirement |
---|---|---|
0004-05 |
General Denial - No Information |
List items that you asked for that were not provided. |
0006-03 |
GA Termination on Reconsideration |
List items that you asked for that were not provided. |
0006-04 |
GA Termination for Clear Improvement |
On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now. Or You work # hours per week for (employer) as a (position). |
0006-05 |
GA Termination for No Medical Information |
On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items |
0006-06 |
GA Termination for Medical Evidence Inconclusive |
On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items |
0006-07 |
GA Termination for No Incapacity - Prior Error |
We made a mistake when we put you on GAU on (date). You did not meet our requirements because _________ (enter case specific information regarding the medical information received and why it doesn't meet severity and/or duration requirements - e.g. "The information we got from Dr. Sun showed your back injury was not severe enough to keep you from doing light work that you have done in the past."). |
0020-01 |
MN Spenddown |
In the first mandatory freeform text section:
In the second mandatory freeform text section:
|
0020-03 |
Bills Received-Spenddown Not Met |
In the first mandatory freeform text section:
In the second mandatory freeform text section:
|
0045-09 |
Overpayment Modification |
State why the overpayment is being modified. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
0070-05 |
ETR Denial |
State why the ETR was denied. |