Free-form text for ACES letters

Revised Date: 
July 25, 2014

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:

  • List the bills used to meet spenddown / EMER

In the second mandatory freeform text section:

  • List all the bills you did not use and why you didn't use them.

0020-03

Bills Received-Spenddown Not Met

In the first mandatory freeform text section:

  • List the bills used to meet spenddown / EMER

In the second mandatory freeform text section:

  • List all the bills you did not use and why you didn't use them.

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.