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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.
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C-IV and CalHEERS Communication Flow
Key Terms
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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.
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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
Center for Human Services, UC Davis ExtensionDecember 12, 2013
C-IV Access ChannelEDR
CalHEERS Access Channel
DERDS
Images/NOAs
DERDS
January 2014
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C-IV CalHEERS
Center for Human Services, UC Davis ExtensionDecember 12, 2013
New Screens
MAGI Images Transfer SummaryMAGI Person DetailMAGI Referral DetailMAGI Referral SearchMAGI Determination ListMAGI Determination DetailTax Household ListTax Household DetailInformation Update DetailMAGI Determination Summary
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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.
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Marci LaLa
Marci LaLa calledCovered CA to sign upfor health coverage.Application wasreferred to theapplicable countybecause it appears shemay be eligible forMedi-Cal.
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MAGI Referral Search
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Navigation Path-Case Info>e-Tools>Magi
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MAGI Referral Search
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Case Summary
MAGI Referral Detail Page
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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.
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Referral Status
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Types of Statuses:• Pending• Ineligible• Eligible• Conditionally
Eligible
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MAGI Person Detail Page
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Tax Filer Information
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Verification
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View Differences
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Questions
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Case Summary
Case Summary-New Role
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Navigation-Case Summary>Applicable Program>View Details>Admin Role
Center for Human Services, UC Davis ExtensionDecember 12, 2013
Admin Role-CEC
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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
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Individual Demographics
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Indian Tribes
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Ethnic Origin
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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.
Center for Human Services, UC Davis ExtensionDecember 12, 2013
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
Center for Human Services, UC Davis ExtensionDecember 12, 2013
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.
Select the member of your case here
Center for Human Services, UC Davis ExtensionDecember 12, 2013
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 the member of your case here
Select Yes or No
Center for Human Services, UC Davis ExtensionDecember 12, 2013
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
Center for Human Services, UC Davis ExtensionDecember 12, 2013
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
Center for Human Services, UC Davis ExtensionDecember 12, 2013
Validation Page
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Sample – Validation received when attempting to input a duplicate tax household record.
Center for Human Services, UC Davis ExtensionDecember 12, 2013
Two Tax Filers
We have Grace andHarold Barney whoare a married couplefiling jointly. Graceis the primary taxfiler.
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Primary Tax filer
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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.
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Requesting MAGI Determination
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More About the MAGIDetermination Page
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Life Change Event
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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.
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Message Center
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Double click the globe icon to open the message center.
Center for Human Services, UC Davis ExtensionDecember 12, 2013
Message Center
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Message Center
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MAGI Determination Summary
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MAGI Determination Detail
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Questions
Running EDBC Error Message
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EDBC Results
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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
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Negative Action
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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
Center for Human Services, UC Davis ExtensionDecember 12, 2013
Summary of Inter AgencyReferrals and Transactions
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MAGI Images Summary
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Navigation Path: Eligibility>Distributed Documents> MAGI Images Summary
Center for Human Services, UC Davis ExtensionDecember 12, 2013
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.
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Image Transfer Summary
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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.