Human Resources Administration Department of Social Services 1 Eligibility Data and Image Transfer System EDITS November 6, 2008

Human Resources Administration Department of Social Services 2 Sam Morcos Assistant Deputy Commissioner Information Technology & Client Services NYC Human Resources Administration Medical Insurance & Community Services Administration Tel. (212) Catherine Ray Director Administrative and Operational Technology Solutions NYC Human Resources Administration Management Information Systems Tel. (718) Contacts

Human Resources Administration Department of Social Services 3 Introduction Expansion of public health insurance and keeping eligible persons enrolled has been a city and state goal since welfare reform. Unlike other programs Public health insurance permits delegation of the application face to face interview to certified representatives or facilitated enrollers. Medical providers (hospitals, nursing homes, and managed care plans) as well as community based organizations, perform this role in New York City. Many of these entities have automated systems to collect public health insurance application data and print it on the applications that are then sent in hard copy to MICSA for review and entry to WMS. Since 2000, over 79% of the monthly volume of 48,827 applications is submitted by these intermediaries in this manual fashion.

Human Resources Administration Department of Social Services 4 What is EDITS? Receives data and images transferred from the systems of certified submitters Commits images automatically into the HRA image repository Provides the HRA eligibility worker access to the Applicant’s data and the supporting documentation on the desktop Automates application registration into WMS and prepares application records for review and eligibility determination by HRA-MICSA staff Presents initially submitted budget data for worker review, adjustment and approval Transfers data and decisions to WMS Provides submitters electronic data containing application decisions EDITS is a front-end system to WMS for Public Health Insurance that:

Human Resources Administration Department of Social Services 5 Very Important Facts EDITS is a NYC owned system. EDITS is not mandatory. Upon delivery of completed EDITS application, NYC HRA MIS will have full responsibility for maintenance and future enhancements. Only authorized HRA employees have direct access to EDITS. Submitters cannot see or access EDITS directly. They can only submit data and image files for EDITS’ use. To join EDITS, submitters must have their own system to collect data and images. Submitters have the choice of using their own IT departments or contracted services to develop a system capable of creating files according to EDITS specifications. Submitters are responsible for developing and maintaining their own systems (which include hardware and software) to remain in compliance with any changes resulting from State WMS enhancements/changes that affect EDITS.

Human Resources Administration Department of Social Services 6 Medicaid Caseload PRWORA 1996PRWORA 1996 HCRA2000HCRA2000 DRM2001DRM2001 FHP2002FHP2002

Human Resources Administration Department of Social Services 7 FTP SERVER IN DMZ SUBMITTERS EDITS FTP Firewall System Overview

Human Resources Administration Department of Social Services 8 EDITS behind the scene processes EDITS ensures compliance with Medicaid policies by: –Validating data and images files transmitted by submitters –Performing completeness and accuracy test for each application record –Rejecting incomplete/inaccurate application records and notifying submitter of rejection and reason(s) –Monitoring timeliness of submission and process of applications Application Registration into NYS WMS system and obtain registration number Prepare application records for supervisory assignment

Human Resources Administration Department of Social Services 9 EDITS Impact on Provider’s Process BEFOREAFTER 1. Pre-Screen potential applicants 2. Conduct interview 3. Collect completed applications 4. Collect required documentation 5. Copy required documentation for each application 6. Data enter application data into their own information system5. Data enter application data into their own information system 7. Image documentation into their own information system6. Image documentation into their own information system 8. Prepare a transmittal for applications that are ready for submission to MICSA 9. Send applications and documentation via a messenger to MICSA 10. Obtain a signed receipt from MICSA for submitted applications 11. Follow up calls to HRA inquiring about application status 12. Collect Turn-around Document (TAD) 7. Transmit electronic Data and Image files to EDITS

Human Resources Administration Department of Social Services 10 EDITS Impact on MICSA’s Process BEFOREAFTER 1. Receive paper batches of applications 2. Maintain manual files in date order to ensure timely processing 3. Audit application records and documents to ensure appropriate and complete submissions 4. Return incomplete/inappropriate records to submitter 5. Register application into State Welfare Management System (WMS) 6. Wait for Resource File Integration (RFI) 3-5 days1. Wait for Resource File Integration (RFI) 3-5 days 7. Data enter application information and financial data into State Welfare Management System (WMS) 8. Review consumer data and supporting documentation2. Review consumer data and supporting documentation 9. Provide a decision3. Provide a decision 10.Supervisor review, approval, and transmission to WMS4.Supervisor review, approval, and transmission to WMS 11. Create decision notification to applicant and submitter 12. Prepare case records for imaging 13. Collection of Case records by imaging agent 14. Imaging of records by agent 15. Submission of images to HRA MIS 16. Storage of images into HRA repository 17. Respond to submitter inquires on case status5. Respond to submitter inquires on case status 18. Respond to error correction requests from submitters

Human Resources Administration Department of Social Services 11 Productivity Increases Manually EDITS Applications Per Worker Per Day 12 Applications15 Applications Time to complete eligibility decision 25 Days15 Days

Human Resources Administration Department of Social Services 12 EDITS Growth 2005 Initial Implementation 2008 YTD 9/30/08 Certified Submitters 13 Approved Providers 4988

Human Resources Administration Department of Social Services 13 Certification Process The Submitter must successfully pass the Certification Process on the test environment in order to proceed with EDITS. The process is detailed in the Submitters Specifications Document posted on the EDITS web site.