C-IV CalHEERS Interface December 12, 2013. Overview The CalHEERS project will provide a unified access point for clients to apply for medical benefits

C-IV CalHEERS InterfaceDecember 12, 2013

Overview

The CalHEERS project will provide a unified access point for clients to apply for medical benefits and select insurance plans. In order to receive and capture the information collected by the Covered CA agents, new interfaces with SAWS systems will be built to send and receive data. C-IV has made changes to existing pages and added new pages in order to capture the information and run EDBC rules through an external rules engine.

2Center for Human Services, UC Davis ExtensionDecember 12, 2013

Jennifer Hobbs

suggest saying:C-IV has made changes to existing pages and added new pages in order to capture the information and run EDBC rules through an external rules engine.rather then 'from'just a suggestion


C-IV and CalHEERS Communication Flow

Key Terms


Batches• There are five new batch types that have been added to C-IV for

CalHEERS communication. – EDR (Eligibility Determination Request) – C-IV to CalHEERS in real time.– DER (Determination Eligibility Response) – CalHEERS to C-IV in real time. – Disposition – C-IV to CalHEERS in real time. – Update – can be initiated by either system in an overnight batch process.– Document Manifest (Images/NOAs)– Document Manifest is a file that is

included with the images that are sent over in the encrypted zip file. It includes the case name, ID, county, image type etc. It can be initiated by either system in an overnight batch process.

• The batch system ensures that the two systems can communicate changes and referrals to one another along with the resulting eligibility determinations.


Access Channel Flow for CalHEERSand the Federal Hub

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CalHEERS Federal Hub

Center for Human Services, UC Davis ExtensionDecember 12, 2013

CalHEERS Access Channel

Customer DataIncome, SSN, Tax Filer, etc.

e-Verification for Customer Info

Fed Hub Access Channel

Access Channel Flow for C-IVand CalHEERS

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C-IV CalHEERS


C-IV Access ChannelEDR

CalHEERS Access Channel

DERDS

Images/NOAs

DERDS

January 2014

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C-IV CalHEERS


New Screens

MAGI Images Transfer SummaryMAGI Person DetailMAGI Referral DetailMAGI Referral SearchMAGI Determination ListMAGI Determination DetailTax Household ListTax Household DetailInformation Update DetailMAGI Determination Summary


Revised ScreensInter-Agency Transfer Summary - was referred toas Targeted Low Income Summary.Case Summary - updated to include access to thenew MAGI pages.Individual Demographics - added additional fields for no SSN, Indian Tribe information, and ethnic origin.Customer Options - three new options added.Run EDBC - added the request to run MAGIdetermination.


Marci LaLa

Marci LaLa calledCovered CA to sign upfor health coverage.Application wasreferred to theapplicable countybecause it appears shemay be eligible forMedi-Cal.


MAGI Referral Search

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Navigation Path-Case Info>e-Tools>Magi


MAGI Referral Search

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Case Summary

MAGI Referral Detail Page


MAGI Referral Detail

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Status Options:• Received• In Process • Reviewed • Complete

You can navigate to the MAGI Person Detail page by clicking on the person hyperlink.


Referral Status

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Types of Statuses:• Pending• Ineligible• Eligible• Conditionally

Eligible


MAGI Person Detail Page


Tax Filer Information


Jennifer Hobbs

This page no longer looks like this. Would you like a new screen shot?

Verification


View Differences



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Questions


Case Summary

Case Summary-New Role

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Navigation-Case Summary>Applicable Program>View Details>Admin Role


Admin Role-CEC


Review of IconsWhen you see and click on the arrows iconit will show where the information is coming from:• Covered CA

• C4Yourself

• Targeted Low-Income Families


Individual Demographics


Indian Tribes


Ethnic Origin


Customer Options

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Consent to run MAGI Determination initially and at Renewal. This is required for the primary tax filer.

Request for Non-MAGI determinationThis is required for anyone requesting a Non-MAGI determination.


Jennifer Hobbs

FYI. We found out today that this is not required to run MAGI MC...only APTC and CSR...as such our design may change once we have confirmed with DHCS.Just an FYI

Maintain Verifications

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Maintain Verifications Detail – includes the mandatory field “Maintain Verifications for the following years.” Options include: 1,2,3,4,5 and No tax returns checked at renewal.

Select the member of your case here

Navigation Path: Customer Information>Non-Financial > Customer Options


Verification Consent

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Verification Consent is used when running the initial MAGI determination.

The “I agree to consent for Verification” is a yes or no question.



Full Medi-Cal Hierarchy

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Full Medi-Cal Hierarchy is used to indicate that a Non-MAGI determination is requested.

If an individual is not eligible to Non-MAGI then the option to elect MAGI or Non-MAGI will not be available in EDBC.


Select Yes or No


Tax Household

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Tax Household List page – Every person in the household must be associated to a tax filing status.

Navigation Path: Customer Information>Financial > Tax Household


Tax Household Detail

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Tax Household Detail – Allows input of Filing Status: Single, Head of Household, Married Filing Jointly, Married Filing Separately

Dependent Types: Non-Custodial Parent and Tax Dependent


Validation Page

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Sample – Validation received when attempting to input a duplicate tax household record.


Jennifer Hobbs

Note. you can have two tax household pages, if needed; however there can only be ONE primary tax filer per case.

Two Tax Filers

We have Grace andHarold Barney whoare a married couplefiling jointly. Graceis the primary taxfiler.


Primary Tax filer


Requesting MAGI Determination

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Reminder:Before MAGI Eligibility can be run, you MUST have the primary tax filer information completed on the Tax Household list and the Customer Options page and the relationship grid completed.


Requesting MAGI Determination


More About the MAGIDetermination Page


Life Change Event


The Hub• The first time a case is ran for MAGI determination,

the Hub will send back a pending eligibility response. This is due to the fact that The Hub cannot check for residency.

• The recommended process is to run a second MAGI determination for CalHEERS to accept the sight verified residency.

• In response to the second MAGI determination request, CalHEERS will update residency to Admin-verified on the MAGI Person Detail page.


Message Center

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Double click the globe icon to open the message center.


Message Center


Message Center


MAGI Determination Summary


MAGI Determination Detail



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Questions

Running EDBC Error Message


EDBC Results


Negative ActionsIn order to run negativeaction, you have to go back to the MAGI eligibility tab.• Check Request Negative

Action Determination• Select the Person(s)• Choose a Negative

Action Reason from the drop-down

• Click Request MAGI


Negative Action


Inter-Agency Transfer Summary

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This placeholder was called the Targeted-Low Income Summary

Navigation Path: Case Summary>Inter-Agency Transfer Summary


Summary of Inter AgencyReferrals and Transactions


MAGI Images Summary

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Navigation Path: Eligibility>Distributed Documents> MAGI Images Summary


MAGI Image SummaryTo access the MAGI Images Transfer Summary• Click on Distributed Documents from the Global bar. • Click on MAGI Images Transfer Summary. • This screen will functionally run the same as Distributed

Documents. You will be given the choice to search using certain criteria (such as a range of dates).

You will notice that there are buttons labeled “View Image.” This will take you to WebNow to view the image.

The document will also need to be indexed similar to how we

currently receive images from other counties with eICT’s.

CalHEERS will send any/all documents that the customer uploads Into CalHEERS as one package once a day.


Image Transfer Summary


Objectives Met Today• Discussed the communication flow between C-IV and

CalHEERS once the interface is operational.• Reviewed the new screens created to capture the

information collected required by Healthcare Reform.• Reviewed the revised screens need to capture the

information collected required by Healthcare Reform.• Reviewed MAGI determination request and Message

Center functionality.• Reviewed how images and Notices of Actions will be

stored in the system.



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Questions

Thank you for participating

today.