1. Oklahoma Health Care Authority
Online Enrollment
(Easy as 1-2-3)

2. What’s In a Name? What Is Online Enrollment? SoonerCare Comprehensive
Web App For
For State
Sponsored
Medical
Programs
Streamlines Policy, Processes, and Access to Services
Real-time Eligibility, Enrollment, and ID Generation
SoonerCare
Concept submitted to CMS in summer of 2007.
Work began after approval December 2007
Launched: Sept. 7,

3. Why Did We Do It? Over 500,000 Non-Insured Oklahomans
22% Of Uninsured Live In Rural Areas
- Limited access to OKDHS offices
Oklahomans Are Unsure If They Qualify
- It’s Healthcare, Not Welfare
- Private, real-time determination available 24/7
Enrollment Process is Broken
- Dependency upon Legacy Mainframe
- Client Numbering
- Streamline enrollment and verification
- Intuitive application with editing controls

4. What Were the Goals? Remove Barriers that Prevent Enrollment
Empower and Equip the Members
Develop Multiple Program Application
Expand Enrollment to Service Locations
Remove Barriers that Prevent Enrollment
Increase Effectiveness/Efficiency of Process

5. Was State Policy Affected?
Changing the Way We Do Business
Date Specific Eligibility
Rolling Redetermination
Medical Home at Application

6. Why No Wrong Door? Home View Agency View Paper Application Agency
Applying at Home Computer
or Community Partner
Home View
Applying at Agency Partner
Agency View
Completing Paper Form
Mail to HP For Scanning
Paper
Application
Comprehensive Applicant
at Welfare Office
Agency
Electronic
Notification of DOS
NODOS App
Behavioral Health
DMH App
Newborn Registration
e-NB-1 App

7. Who was Affected? Phase II Phase II.5 Initial Phase
Children, Pregnancy, Families
Family Planning waiver
Behavioral Health Services
For the initial phase the online application will be available for the following populations:
Low hanging fruit – low cost, high value population
Children – 185% FPL
Pregnant women – 185% FPL
Adults with minor children – 37% FPL
Individuals seeking family planning and – 185% FPL
Individuals seeking behavioral health services – 200% FPL
THIS COVERS nearly 500,000 of the 700,000 unduplicated we serve in a given year. 70% of the population.
Next tier: IO & BCC
Lower Yield: ABD, Nursing homes, Home community based waivers
Phase II
Insure Oklahoma (Premium Asst)
Oklahoma Cares (BCC)
Women, Infants, & Children Nutrition
Phase II.5
Affordable Care Act

8. Where To Start? Unique ID Call Center Other Programs Data Exchange
Letters Notices
Rules Engine
Partners
PCP Choice
Date Specific
Verifications
Real-time Enrollment
Adding Newborns
Rolling Reviews
Appeals
PERM/MEQC
Security

9. Simplification Is Not Simple
OKDHS Agency Electronic
OKDHS NON-OE (ABD)
ID #
Letters
ID Cards
Agency View
Home View
MMIS Eligibility Subsystem
Rules Engine
Yes
MMIS
Recipient
NH, Waiver, BCC, Premium Asst, Custody,….etc
Paper Mailed
Real
Time
Scan-Data Entry
Reason
/ Member No
Member ID Assigned
BH App
NODOS
Denial
Letter
E-NB1

10. What About Verifications?
SSN
Social Security Administration
Agency Partners
Pregnancy
Function – who we are working with
SSN verification – income verification -
OSDH pregnancy exchange / WIC eligibility
Citizenship / pregnancy verification-validation
CSED – TPL info; non-preg adults with children have to play
Interfaces
NWD will interface with other agencies to
verify client data and
increase program integrity.
Interfaces occur in batch processing or real-time.
Results of the interface queries may
Be sent to the user via on-line alerts or
Trigger automated update to a client's record
Require the user to assist in the disposition of the discrepancy.
NWD will interface with SSA, OKDHS, OESC, and OSHD, among others.
Income
OK Employment Securities
Commission (OESC)
OSDH, Electronic Verification of
Vital Events, Systematic Alien
Verification for Entitlements
Citizenship

11. Entered into System By Call Center Rep
Manual Verifications
Coversheet
(From Website)
Mailed
Due Date ATN Name Case # HP
Scanned to Workflow
Entered into System By Call Center Rep

12. How Does One Apply? Home View Agency View Paper Application Agency
Applying at Home Computer
or Community Partner
Home View
Applying at Agency Partner
Agency View
Completing Paper Form
Mail to HP For Scanning
Paper
Application
Comprehensive Applicant
Presents at County Office
Agency
Electronic

13. At-Home & Community Partner Options
Programs Affected
What is Needed
FAQ’s
Income Guidelines
Tell Me More
SoonerCare
SoonerPlan
Apply Now
Manage Account
Review Benefits
Check Status
Update Information

14. Agency Partner Options
Search & Submit
SoonerCare
SoonerPlan
View/Update
Verifications
Pregnancy
Citizenship
Identity
Paper app process- EDS sun guard – entire state ~20000
Eligibility Alerts
Certification Ending
Domestic Violence
Manage Member
Review Benefits
Check Status
Update Information

15. Paper Application Mail Paper To HP Scan and Data Entry Rules Engine
Paper app process- EDS sun guard – entire state ~20000
Rules Engine
Letter-Notices-ID

16. Processing Continues for Additional Benefits
Agency Electronic
OKDHS Interface
DHS Mainframe
Rules Engine
HTML
Data Gathered
Demographics gathered in Mainframe
HTML transaction sent to OHCA OE Rules Engine
Eligibility decision made and Enrollment completed
Approval or denial reason returned
Processing continues for additional benefits No
Denial Reason
Eligible?
Processing Continues for Additional Benefits
Yes
Update Recipient
Approval
Welcome Letter

17. Electronic Notification of DOS Certify For Date of NODOS –5 days
ID #
Rules Engine
Application
NODOS
Certify For Date of App No
Patient on App?
Yes
Certify For Date of NODOS –5 days No
15 days NODOS?
Yes

18. What Got Better? OLD WAY NEW WAY Apply 24hrs/7days
Available: M/F, 8am-5pm
Apply 24hrs/7days
20-30 Days For Results
Real Time Eligibility
Individual Policy Interpret
Policy Uniformly Applied
No Primary Care Provider
Medical Home - Enrollment
Process Differs By County
Streamline Business Process
Imprecise data
Normalized data

19. Yeah…We’re Kickin’ Apps 232,527 Applications Received
& Takin’ Names
April – September 2011
232,527 Applications Received
Opened/Extended ,597
New Application 108, Recertification ,802
Denied ,930
New Application 33, Recertification ,125

20. Source Average (6 months)
April – September 2011

21. Source Trend (6 months)
April – September 2011

22. Blizzard In Oklahoma
Application Status Feb 1st Feb 2nd Total Denied Opened Total
Health Program New Apps Recert Total STBS SoonerCare SoonerPlan Total
HOME INTERNET 87%
Agency Electronic 10%
Agency Internet 3%

23. “The Days the State Stood Still”
February 3, 2011
Blizzard in Oklahoma!
THE DAYS THE STATE STOOD STILL
(Or Did It?)
OE Enrolls 780 in SoonerCare with Virtually Every County Office in the State Closed!
Governor Fallin declares Online Enrollment Days!

24. Be Careful What You Wish For
eMPI – Client Numbering and Normalization
Confusion – Applicants/Members/Partners/Co-workers
Human Services – County Coordination is Imperative
Call Centers – Staff Up!
Organization – Enrollment Operation Structure
Automation – Data Driven System (the good, the bad & the ugly)
Conversion – Auto-populate what you don’t have
Compatibility – Browsers and Pop-up Blockers
Staffing – You’re going to need some experts!
Design Outside Box – Generic Family & Optional Denial Letter

25. We Got Some Phone Calls

26. Online Enrollment -- Answer Rates

27. Online Enrollment Effect on Total Calls

28. Where Do We Go From Here? Phase II – Additional Populations
Insure Oklahoma (Premium Asst)
Oklahoma Cares (BCC)
WIC
Phase III - Health Insurance Exchange
Affordable Care Act
Partnership with Insurance & Health Department
Rules Engine Modifications
Phase IV – Enrollment Data Exchanges
Other Agencies and Programs
Interfaces with Welfare Programs, WIC,

29. Future – Gather and Verify Data, Rules Gather Family Demographics

30. Future – Apply Rules, Evaluate, Enroll
Real-time
Decision
and
Enroll
Rules Engine
Function – who we are working with
SSN verification – income verification -
OSDH pregnancy exchange / WIC eligibility
Citizenship / pregnancy verification-validation
CSED – TPL info; non-preg adults with children have to play
Interfaces
NWD will interface with other agencies to
verify client data and
increase program integrity.
Interfaces occur in batch processing or real-time.
Results of the interface queries may
Be sent to the user via on-line alerts or
Trigger automated update to a client's record
Require the user to assist in the disposition of the discrepancy.
NWD will interface with SSA, OKDHS, OESC, and OSHD, among others.
Numbering
Client

31. Future – Enroll, Distribute
OKDHS
Community
Partners
Real-time
Decision
and
Enroll
Recipient
Database
Insurance
Exchange
Function – who we are working with
SSN verification – income verification -
OSDH pregnancy exchange / WIC eligibility
Citizenship / pregnancy verification-validation
CSED – TPL info; non-preg adults with children have to play
Interfaces
NWD will interface with other agencies to
verify client data and
increase program integrity.
Interfaces occur in batch processing or real-time.
Results of the interface queries may
Be sent to the user via on-line alerts or
Trigger automated update to a client's record
Require the user to assist in the disposition of the discrepancy.
NWD will interface with SSA, OKDHS, OESC, and OSHD, among others.
State Dept
Of Health
Native
American
Tribes

32. Did We Learn Any Lessons? As A Matter of Fact…We Did!
It Really Does Take a Village
Build Partnerships
Keep Them Alive
Design Tool – HP Wireframe
Focus Groups/Application Flow
A Variety of Approaches Are Critical
Like “Esurance”, technology when you want it… people when you don’t.

33. Dustin Oxford Enrollment Automation Oklahoma Healthcare Authority