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C-IV CalHEERS Interface

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Presentation on theme: "C-IV CalHEERS Interface"— Presentation transcript:

1 C-IV CalHEERS Interface
December 12, 2013

2 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. There are 13 new pages. There are changes to existing pages as well. One of the pages changed is the Targeted Low Income Families. It will now be known as the Inter Agency Transfer Summary or IAT. Before we talk about the changes and additional pages, let’s review some key terms and review how information will move between the C-IV and CalHEERS systems. Center for Human Services, UC Davis Extension December 12, 2013

3 C-IV and CalHEERS Communication Flow
Center for Human Services, UC Davis Extension December 12, 2013

4 Key Terms Center for Human Services, UC Davis Extension
December 12, 2013

5 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. Center for Human Services, UC Davis Extension December 12, 2013

6 Access Channel Flow for CalHEERS and the Federal Hub
CalHEERS Access Channel Federal Hub CalHEERS Customer Data Income, SSN, Tax Filer, etc. e-Verification for Customer Info Fed Hub Access Channel Center for Human Services, UC Davis Extension December 12, 2013

7 Access Channel Flow for C-IV and CalHEERS
C-IV Access Channel EDR CalHEERS C-IV DER DS Images/NOAs CalHEERS Access Channel DER DS Center for Human Services, UC Davis Extension December 12, 2013

8 January 2014 C-IV CalHEERS Currently we are receiving the pending MAGI applications through an excel spreadsheet. Once the release has been uploaded, CalHEERS will send the pending applications through the interface. The release will be completed on December 30th but it is unknown at this time when the apps will start coming over. CalHEERS and C-IV are working out the details. Let’s talk about the new screens and screens that have been changed. Center for Human Services, UC Davis Extension December 12, 2013

9 New Screens MAGI Images Transfer Summary MAGI Person Detail MAGI Referral Detail MAGI Referral Search MAGI Determination List MAGI Determination Detail Tax Household List Tax Household Detail Information Update Detail MAGI Determination Summary Center for Human Services, UC Davis Extension December 12, 2013

10 Revised Screens Inter-Agency Transfer Summary - was referred to as Targeted Low Income Summary. Case Summary - updated to include access to the new 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 MAGI determination. We will review the new and improved screens by walking through a pending referral from CalHEERS. Center for Human Services, UC Davis Extension December 12, 2013

11 Marci LaLa Marci LaLa called Covered CA to sign up for health coverage. Application was referred to the applicable county because it appears she may be eligible for Medi-Cal. Center for Human Services, UC Davis Extension December 12, 2013

12 MAGI Referral Search Navigation Path-Case Info>e-Tools>Magi
This will be the starting point for the communication between C-IV and CalHEERS. This page will alert us to the different types of referrals or change requests that have been submitted. The functionality of this page is very similar to other e-transactions. (eICT’s, e-apps, IAT’s, etc.) Type: There are four types that will batch from CalHEERS to C-IV: Determination Change – This is a referral that has come to the C-IV System from CalHEERS as a result of eligibility changes in the CalHEERS system. This was not requested from the C-IV System, but it is for a case that is already established in the C-IV System and known to CalHEERS. This is pre-linked to the corresponding C-IV case. This is change that will affect eligibility. Determination Response – This is a referral that has come to the C-IV System from CalHEERS as a result of a Determination Request that was sent from the C-IV System. Since the Request was sent from a specific case, this will be pre-linked to the corresponding C-IV case. In other words, we have requested a MAGI determination and CalHEERS is responding to our request. Information Change – This is a referral that has come to the C-IV System from CalHEERS as a result of changes in the CalHEERS system. This referral does not contain any eligibility determination, as the changes to the case do not warrant an updated determination of benefits. In other words, the worker does not need to run EDBC. This was not requested from the C-IV System but it is for a case that is already established in the C-IV System and known to CalHEERS. This will be pre-linked to the corresponding C-IV case. Task is auto-generated when information update is received in the C-IV system. Referral – This is a referral that has come to the C-IV System from CalHEERS for a case that may not be known to the C-IV System yet. Counties are required to link this referral to a C-IV case. Navigation Path-Case Info>e-Tools>Magi Center for Human Services, UC Davis Extension December 12, 2013

13 MAGI Referral Search Case Summary MAGI Referral Detail Page
The date and time stamp hyperlink will take you to the MAGI Referral Detail page. If the referral has been linked to a C-IV case, you will see the case number. Clicking on the C-IV case number hyperlink will take you to the case summary page. Let’s talk about the types of status you will see. MAGI Referral Detail Page Center for Human Services, UC Davis Extension December 12, 2013

14 MAGI Referral Detail Status Options: Received In Process Reviewed
Complete You can navigate to the MAGI Person Detail page by clicking on the person hyperlink. After finding your referral and clicking on the date and time stamp you navigate to the MAGI referral detail page where you can link the referral to a new or existing C-IV case. The process to link works just like it does for the e-apps from C4Yourself. Best practice is to review the information populated on the screen. If the client has requested an application for other programs you will see the check marks next to each program listed. If the referral shows the client has requested additional programs, follow your county polices in addressing those requests. Once the referral has been linked we will see the unlink button. That process remains unchanged. We also be able to edit the page. The status is also updated and are: Received – When a referral is received from CalHEERS. In Process – When a MAGI referral has been linked to a C-IV case. Reviewed – All the data collection pages have been reviewed and EDBC is ready to run. Complete – EDBC has been run and a disposition has been sent. You can navigate to the MAGI Person Detail page by clicking on the person hyperlink. You will also see the status of the CalHEERS application. Center for Human Services, UC Davis Extension December 12, 2013

15 Referral Status Types of Statuses: Pending Ineligible Eligible
Conditionally Eligible Pending: The person would be eligible, but is not due to one of these reasons: The income is not reasonably compatible The person is not a state resident the person is incarcerated The person is deceased and the date of death has not been given Ineligible: The person is not eligible Eligible: The person is eligible for the program The citizenship and SSN is verified The income is reasonably compatible, The person is a resident, The person is verified not incarcerated The person is not deceased or the date of death has been given and is not in a month prior to application. Conditionally Eligible: Citizenship Verification Incompatible – ends 90 days from the date the person is determined conditionally eligible SSN Verification – ends 60 days from the date the person submitted the application Immigration Status – ends 30 days from the date the person is determined eligible We have linked Marci’s referral to a C-IV case and now can move onto processing the referral. Center for Human Services, UC Davis Extension December 12, 2013

16 MAGI Person Detail Page
You can navigate to this page by clicking on the person hyperlink located on the MAGI referral page. Best Practice-review page as you do now when processing e-apps. The person detail page is formatted in the same flow as the e-apps and will show the information captured in CalHEEERS such as the who is the primary tax filer and what information has been provided and verified in CalHEERS. Center for Human Services, UC Davis Extension December 12, 2013

17 Tax Filer Information Center for Human Services, UC Davis Extension
December 12, 2013

18 Verification Admin-verified section lists to the information that has been provided to CalHEERS or the local CWD. E-Verified section lists the information confirmed from the Federal Hub. Note: if you receive an Information Update response you will click on the “View Differences” button. The page will reappear and look like this (move onto next slide) Center for Human Services, UC Davis Extension December 12, 2013

19 View Differences When the page reappears you will only see what changes have been reported to CalHEERS. The rest of the page will be faded and gray. Okay, we have linked Marci’s referral and now ready to process the information populated in Customer Information. Before we move on let’s stop for a moment for Questions. Center for Human Services, UC Davis Extension December 12, 2013

20 Questions Center for Human Services, UC Davis Extension
December 12, 2013

21 Case Summary Marci’s case has been linked and we are ready to process the referral in the C-IV system. Center for Human Services, UC Davis Extension December 12, 2013

22 Case Summary-New Role A new administrative role has been added to address the Certified Enrollment Counselor information in CalHEERS. In the CalHEERS system, the CEC is considered an authorized representative. This does not mean the same in the Medi-Cal program. The CEC has been authorized to make and accept changes in the CalHEERS case but does not meet the current rules for an authorized representative in the Medi-Cal program. This role is informational only in C-IV. We have a new screen to complete that captures that information on the next slide. Navigation-Case Summary>Applicable Program>View Details>Admin Role Center for Human Services, UC Davis Extension December 12, 2013

23 Admin Role-CEC You would find this information on the MAGI Referral Detail page under Authorized Representative. Let’s move onto the Customer Information tab. As we move through the Non-Financial and Financial pages we will see new icons. Center for Human Services, UC Davis Extension December 12, 2013

24 Review of Icons When you see and click on the arrows icon
it will show where the information is coming from: Covered CA C4Yourself Targeted Low-Income Families Now we are ready to navigate through the non-financial and financial pages so we can process Marci’s referral. Center for Human Services, UC Davis Extension December 12, 2013

25 Individual Demographics
In an effort to obtain information quicker from the Federal Hub, the Reason for no SSN field displays on the Individual Demographics Detail page when No SSN is selected from the SSN Status drop-down box. The reasons are: ATIN/ITIN ATIN is Adoption Tax Identification Number ITIN is Individual Tax Identification Number When ATIN/ITIN is selected a new text box appears to allow the User to enter the number. If ATIN/ITIN is selected as the reason for no SSN, the ATIN/ITIN text field is mandatory. The options are: Child Under Age 1 I do not qualify for an SSN Religious Exemption Center for Human Services, UC Davis Extension December 12, 2013

26 Indian Tribes Federally-Recognized Indian Tribe
In an effort to obtain information quicker from the Federal Hub, the Is this person a member of a Federally-recognized Indian Tribe drop-down box displays on the Individual Demographics Detail page. When Yes is selected, the Worker needs to answer two additional questions on behalf of the Customer: To which State does the Tribe belong to? and What is the name of the Tribe? Note: In case a tribe does not display, the worker needs to log in a trouble ticket in order for C-IV to confirm with Covered CA if the tribe should be added. Center for Human Services, UC Davis Extension December 12, 2013

27 Ethnic Origin Under Hispanic additional ethnicity has been added.
Center for Human Services, UC Davis Extension December 12, 2013

28 Customer Options Consent to run MAGI Determination initially and at Renewal. This is required for the primary tax filer. Request for Non-MAGI determination This is required for anyone requesting a Non-MAGI determination. The Customer Options page will be used to capture the customer’s : 1. Consent to run eligibility against the Federal Data Hub (MAGI determination), 2. Consent to run renewal eligibility against the Federal Data Hub in the future (MAGI determination at renewal) and 3. Request for a non-MAGI determination (Full Medi-Cal Hierarchy). The consent to complete the initial MAGI determination must be input for the primary tax filer and is mandatory; the MAGI determination cannot be run without consent. There is currently a question submitted to the State as to whether this is mandatory for the MAGI determination request. This is the current design for the SCR but may change based on DHCS update. The non-MAGI request is completed on an individual basis and should be completed for every person for whom a Non-MAGI request is needed. If MAGI only is requested this does not need to be input. Center for Human Services, UC Davis Extension December 12, 2013

29 Maintain Verifications
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 Center for Human Services, UC Davis Extension December 12, 2013

30 Verification Consent Select the member of your case here
Verification Consent is used when running the initial MAGI determination. The “I agree to consent for Verification” is a yes or no question. Select the member of your case here Center for Human Services, UC Davis Extension December 12, 2013

31 Full Medi-Cal Hierarchy
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 the member of your case here Select Yes or No The Begin Date field can be filled with the Beginning Date of Aid or the first of the month for the Beginning Date of Aid. Either response will be okay. Center for Human Services, UC Davis Extension December 12, 2013

32 Tax Household Tax Household List page – Every person in the household must be associated to a tax filing status. This has been added to the Financial Section. This is a mandatory field to run MAGI. This determines the tax filing household status. Navigation Path: Customer Information>Financial > Tax Household Center for Human Services, UC Davis Extension December 12, 2013

33 Tax Household Detail 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 These are the only two options for dependent types. Non-Custodial Parent is used when the child is in the home but claimed on taxes by another parent outside the home. Center for Human Services, UC Davis Extension December 12, 2013

34 Validation Page Sample – Validation received when attempting to input a duplicate tax household record. Center for Human Services, UC Davis Extension December 12, 2013

35 Two Tax Filers We have Grace and Harold Barney who are a married couple filing jointly. Grace is the primary tax filer. Another screen can be added when a case has two adults. It is not mandatory. Remember, a spouse is not a dependent. The dependents will need to be added to the primary tax filers’ screen. For situations where there is no primary tax filer, such as an undocumented non citizen, the worker would need to enter “no” in the primary tax filer field and “no” in the “Did this person file taxes the prior year” field. Remember, the primary applicant must have this page completed to run the MAGI determination. Center for Human Services, UC Davis Extension December 12, 2013

36 Primary Tax filer We have completed all applicable screens for Marci and now are ready to run EDBC. With the C-IV Interface functionality, we need to request a MAGI determination first. Center for Human Services, UC Davis Extension December 12, 2013

37 Requesting MAGI Determination
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. MAGI Eligibility is located in Customer Information. It is located right above Run EDBC function. 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. Another important piece of information is the income screens. There must be an earned income screen completed as well in order to request the MAGI Determination. Even if the client does not have earned income, the worker would enter the earned income screen and enter a zero value for the amount of income. The Vital Statistic screen will not be mandatory for MAGI Determination but you still need to have this screen completed before running EDBC for Non–MAGI referrals. Center for Human Services, UC Davis Extension December 12, 2013

38 Requesting MAGI Determination
After the benefit month and MAGI Determination button have been pressed, this will show on the screen while waiting for CalHEERS/Hub responses. Center for Human Services, UC Davis Extension December 12, 2013

39 More About the MAGI Determination Page
1. The Benefit Month will default to the future month. This will also show the history of all the benefit months that have been previously ran. 2. To complete a negative action (such as customer withdrawal), you will select the box labeled “Request Negative Action Determination.” The resulting changes to the page will reflect current functionality on the negative actions task from the Case Summary. 3. The Life Change Event will determine if the customer is eligible to a special enrollment period and this information will be located within the MAGI Referral page. Center for Human Services, UC Davis Extension December 12, 2013

40 Life Change Event These are the options for the special enrollment process. Center for Human Services, UC Davis Extension December 12, 2013

41 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. Center for Human Services, UC Davis Extension December 12, 2013

42 Message Center Double click the globe icon to open the message center.
The Message Center appears once the MAGI determination results have been completed. The message center is both case sensitive and worker sensitive. Ideally, these will come back within seconds upon requesting MAGI determination. In the event that there is a lag in response, the message center will show for one day upon the receipt of the determination. It will also show on any page you are currently working, in or out of the case. The message will automatically drop at the end of the day. The message will show in the workload inventory after it is dropped in the message center. Remember that EDBC cannot be run until after the MAGI determination response (DER) has been received from CalHEERS. Center for Human Services, UC Davis Extension December 12, 2013

43 Message Center There are two hyperlinks in the message. The first indicates the time the message was received and will direct you to the MAGI Referral Detail Page. The second is the case number and will direct you to the case summary. Additionally, the Search Results Summary section updates with the results. By clicking the Benefit Month hyperlink, you can see additional information. Center for Human Services, UC Davis Extension December 12, 2013

44 Message Center In the event that a worker is unable to work a message from the message center the same day they receive it. The CalHEERS icon will show when a case has a MAGI determination that needs to be reviewed and completed. Center for Human Services, UC Davis Extension December 12, 2013

45 MAGI Determination Summary
The Response ID is the unique identifier for each determination transaction sent for a case from CalHEERS. Should you ever need to log a C-IV trouble ticket or CalHEERS ticket through your county’s business process, this ID should be included to expedite research. The Date Run is the date the MAGI determination was process by CalHEERS. Household Eligibility identifies the status of the household as a whole. Possible statuses are: Eligible – All household members are eligible for MAGI Not Eligible – All household members were determined not eligible for MAGI Partially Eligible – At least one household member was determined eligible All household members were determined eligible for MAGI and at least one household member was determined not eligible for MAGI Could Not Determine – At least one household member could not be determined for eligibility. By clicking the Customer Name hyperlink, you can access and view the details received from CalHEERS Center for Human Services, UC Davis Extension December 12, 2013

46 MAGI Determination Detail
After the results have returned, you then need to RUN EDBC. To accept the CalHEERS results into the C-IV System, you must run EDBC after a Request MAGI determination. Previously, EDBC could not be run without a vital statistics record entered for each person; however, since MAGI determines this information through the Federal Hub, EDBC for MAGI ONLY can be run without a vital statistics record created. Before we move onto EDBC, let’s stop for some questions. Center for Human Services, UC Davis Extension December 12, 2013

47 Questions Center for Human Services, UC Davis Extension
December 12, 2013

48 Running EDBC Error Message
Before a case can be ran, MAGI determination MUST be done first. The determination request will be sent to CalHEERS for confirmation from the Federal Hub. You will also notice that the message indicates that the results must be marked as reviewed. The results of the MAGI Determination must be reviewed after a response has been received from CalHEERS before you run the normal EDBC process. This process will be explained in more detail later in presentation. After the MAGI results have been determined, then you MUST run EDBC in order to send the disposition response back to CalHEERS who will send the appropriate notices. If the customer has opted for Full MC Hierarchy, then this is where you can show which choice the customer has made. The functionality of this will be shown later in this presentation. Center for Human Services, UC Davis Extension December 12, 2013

49 EDBC Results Because a customer has an option it’s possible they choose MAGI over Non-MAGI at the last minute. The Medi-Cal EDBC Summary page is where this information is entered. If they elect MAGI their status will become FRI in the non-MAGI budget. The reverse is true if they choose non-MAGI over MAGI. Center for Human Services, UC Davis Extension December 12, 2013

50 Negative Actions In order to run negative
action, 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 Now you must go into negative action where the information should be pre-populated. Center for Human Services, UC Davis Extension December 12, 2013

51 Negative Action A negative action must be sent for MAGI determination and the determination received and reviewed before you can run EDBC and create the notice of action. Center for Human Services, UC Davis Extension December 12, 2013

52 Inter-Agency Transfer Summary
This placeholder was called the Targeted-Low Income Summary When CalHEERS sends the C-IV System a determination of eligibility (whether it was requested in the C-IV System, or it was initiated from the CalHEERS access channel), the C-IV System is required to send a disposition of the determination back to CalHEERS. This disposition includes the C-IV case number, the C-IV Worker information, and Customer’s preferred written language. Navigation Path: Case Summary>Inter-Agency Transfer Summary Center for Human Services, UC Davis Extension December 12, 2013

53 Summary of Inter Agency Referrals and Transactions
This page will be a summary of all the inter-agency referrals and transactions for a specific case. The Agency dropdown filter will default to All. The options available will be Healthy Families and CalHEERS. The Type dropdown filter will dynamically and change based upon the Agency selected. The types of MAGI transactions this page will display are: Referral, Determination Response, Determination Change and Information Update. The Initiated Date hyperlink for the agency CalHEERS will navigate to the MAGI Referral Detail page. If CalHEERS is the Agency selected, the status drop down will have the following values: Complete In Process Reviewed The MAGI Referral Search page will show all referrals, determination changes, information updates, and determination responses received from CalHEERS for the county that the worker is logged in for. The IAT summary will only sow the CalHEERS communications that are associated to the case. At the beginning of the presentation we discussed how the images and NOAs would be communicated or flow between the two systems. Let’s talk about the images next. Center for Human Services, UC Davis Extension December 12, 2013

54 MAGI Images Summary Navigation Path: Eligibility>Distributed Documents> MAGI Images Summary Clicking on the Distributed Documents tab you will now find a new summary page. When CalHEERS sends the C-IV System a determination of eligibility (whether it was requested in the C-IV System, or it was initiated from the CalHEERS access channel), the C-IV System is required to send a disposition of the determination back to CalHEERS. This disposition includes the C-IV case number, the C-IV Worker information, and Customer’s preferred written language. Once the notice is generated, the CalHEERS packages the notice(s) and any images that the Customer may have uploaded during the day into a single bundle of documents to be sent to the C-IV System. The C-IV System receives these bundles of documents for each case, and extracts the images and notice(s). The images are put into the imaging system and assigned to the Worker(s) associated to the case (just like in the e-ICT process). The notices are saved into the C-IV file management system and associated to the case so that Workers can view it on the Distributed Documents Search page. The notices are scheduled to be sent out through batch on the same night they are received. Center for Human Services, UC Davis Extension December 12, 2013

55 MAGI Image Summary To 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. Center for Human Services, UC Davis Extension December 12, 2013

56 Image Transfer Summary
The Image Transfer Summary is only going to display images that were sent to CalHEERS. This is to help the Worker identify what has been sent to CalHEERS through the automated batch process in the event that there are questions. For inbound images, the Worker may see anything sent from CalHEERS in the normal imaging workflow queue. This follows the same process that is in place for C4Yourself (SAR7s) and inbound e-ICT. Outbound Images When a new image is associated to a case, a process extracts the image(s) that have not yet been sent to CalHEERS and bundles them up for transfer. This is to try to keep CalHEERS and the C-IV System in sync with respect to the associated documentation on a case. County Workers need to associate images to the case as they currently do today. Center for Human Services, UC Davis Extension December 12, 2013

57 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. Center for Human Services, UC Davis Extension December 12, 2013

58 Questions Center for Human Services, UC Davis Extension
December 12, 2013

59 Thank you for participating today.


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