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

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Presentation on theme: "C-IV CalHEERS Interface December 12, 2013. Overview The CalHEERS project will provide a unified access point for clients to apply for medical benefits."— 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. 2 Center for Human Services, UC Davis Extension December 12, 2013

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

4 Key Terms 4 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. 5 Center for Human Services, UC Davis Extension December 12, 2013

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

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

8 January C-IV CalHEERS 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 9 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. 10 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. 11 Center for Human Services, UC Davis Extension December 12, 2013

12 MAGI Referral Search 12 Navigation Path-Case Info>e-Tools>Magi Center for Human Services, UC Davis Extension December 12, 2013

13 MAGI Referral Search 13 Case Summary MAGI Referral Detail Page Center for Human Services, UC Davis Extension December 12, 2013

14 MAGI Referral Detail 14 Status Options: Received In Process Reviewed Complete You can navigate to the MAGI Person Detail page by clicking on the person hyperlink. Center for Human Services, UC Davis Extension December 12, 2013

15 Referral Status 15 Types of Statuses: Pending Ineligible Eligible Conditionally Eligible Center for Human Services, UC Davis Extension December 12, 2013

16 MAGI Person Detail Page 16 Center for Human Services, UC Davis Extension December 12, 2013

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

18 Verification 18 Center for Human Services, UC Davis Extension December 12, 2013

19 View Differences 19 Center for Human Services, UC Davis Extension December 12, 2013

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

21 21 Center for Human Services, UC Davis Extension December 12, 2013 Case Summary

22 Case Summary-New Role 22 Navigation-Case Summary>Applicable Program>View Details>Admin Role Center for Human Services, UC Davis Extension December 12, 2013

23 Admin Role-CEC 23 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 24 Center for Human Services, UC Davis Extension December 12, 2013

25 Individual Demographics 25 Center for Human Services, UC Davis Extension December 12, 2013

26 Indian Tribes 26 Center for Human Services, UC Davis Extension December 12, 2013

27 Ethnic Origin 27 Center for Human Services, UC Davis Extension December 12, 2013

28 Customer Options 28 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. Center for Human Services, UC Davis Extension December 12, 2013

29 Maintain Verifications 29 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 30 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 31 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 Center for Human Services, UC Davis Extension December 12, 2013

32 Tax Household 32 Tax Household List page – Every person in the household must be associated to a tax filing status. Navigation Path: Customer Information>Financial > Tax Household Center for Human Services, UC Davis Extension December 12, 2013

33 Tax Household Detail 33 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 Center for Human Services, UC Davis Extension December 12, 2013

34 Validation Page 34 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. 35 Center for Human Services, UC Davis Extension December 12, 2013

36 Primary Tax filer 36 Center for Human Services, UC Davis Extension December 12, 2013

37 Requesting MAGI Determination 37 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. Center for Human Services, UC Davis Extension December 12, 2013

38 Requesting MAGI Determination 38 Center for Human Services, UC Davis Extension December 12, 2013

39 More About the MAGI Determination Page 39 Center for Human Services, UC Davis Extension December 12, 2013

40 Life Change Event 40 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. 41 Center for Human Services, UC Davis Extension December 12, 2013

42 Message Center 42 Double click the globe icon to open the message center. Center for Human Services, UC Davis Extension December 12, 2013

43 Message Center 43 Center for Human Services, UC Davis Extension December 12, 2013

44 Message Center 44 Center for Human Services, UC Davis Extension December 12, 2013

45 MAGI Determination Summary 45 Center for Human Services, UC Davis Extension December 12, 2013

46 MAGI Determination Detail 46 Center for Human Services, UC Davis Extension December 12, 2013

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

48 Running EDBC Error Message 48 Center for Human Services, UC Davis Extension December 12, 2013

49 EDBC Results 49 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 50 Center for Human Services, UC Davis Extension December 12, 2013

51 Negative Action 51 Center for Human Services, UC Davis Extension December 12, 2013

52 Inter-Agency Transfer Summary 52 This placeholder was called the Targeted- Low Income Summary 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 53 Center for Human Services, UC Davis Extension December 12, 2013

54 MAGI Images Summary 54 Navigation Path: Eligibility>Distributed Documents> MAGI Images Summary 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. 55 Center for Human Services, UC Davis Extension December 12, 2013

56 Image Transfer Summary 56 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. 57 Center for Human Services, UC Davis Extension December 12, 2013

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

59 Thank you for participating today.


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