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OHCA Online Enrollment “Easy as 1-2-3 for SoonerCare members and partners”

OHCA Online Enrollment “Easy as 1-2-3 for SoonerCare members and partners”. Richard Evans, Manager, Eligibility Automation and Data Integrity, OHCA. Web based Application. Streamlines policy and processes. Immediate decision/ information. Online Enrollment Description.

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OHCA Online Enrollment “Easy as 1-2-3 for SoonerCare members and partners”

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  1. OHCA Online Enrollment“Easy as 1-2-3 for SoonerCare members and partners” Richard Evans, Manager, Eligibility Automation and Data Integrity, OHCA

  2. Web based Application Streamlines policy and processes Immediate decision/ information Online Enrollment Description • Launch date: September 7, 2010 for www.mySoonerCare.org • Concept submitted to CMS in summer of 2007. Work began after approval December 2007

  3. Why Create This? • Increase effectiveness and efficiency • Improve client numbering • Streamline enrollment and verification • Intuitive application with editing controls • Vehicle for multiple program applications Phase I populations • SoonerCare (Children, Families, Pregnant) • SoonerPlan (Family Planning Waiver) • State Sponsored Behavioral Health

  4. Why Create This? • Eliminate barriers that prevent applications • Private, real-time determination • Online application available 24/7 • Review/renewal at any time

  5. mySoonerCare.org Services “From the privacy of your own home…” • Provide a place for individuals and families to enroll in SoonerCare coverage • New first time applicants can start an application without scheduling an appointment • Get results and enroll real-time • Select a Medical Home • Provides member the ability to Manage your Account • Review your benefits • Update information

  6. Understanding Multi-Program Interplay “Multiple vehicles for submitting and processing applications…” • Agency View – provides agency partners the ability to be an eligibility broker • Search for member or applicant • Verification of documentation: i.e. pregnancy and citizenship and identity • Update and change member information • Alerts for and Assist with the reenrollment process • Notification of Date of Service form – provides hospitals the ability to reserve a date of application when a full application can not be competed that day. • Allows hospital claims to be paid when a full SoonerCare application is received (within 15 days) and member is determined eligible

  7. Understanding Multi-Program Interplay “Multiple vehicles for submitting and processing applications…” • ODMHSAS provider application – provides facilities the ability to enroll applicants in state sponsored behavioral health services and assigns an ID that they will retain when they apply for SoonerCare • Paper application – remain an option for applicants • Applications are scanned and data entered in system • Just as will all other application types the Rules Engine will make the eligibility decision

  8. Putting the Pieces Together to Serve Members State Department of Health • Providing eligibility resources • Piloting 16 counties with the agency view application • Data exchange for citizenship verifications

  9. Putting the Pieces Together to Serve Members Department of Human Services • Providing eligibility resources • SoonerCare only clients assisted through agency view or mySoonerCare.org • System interface for comprehensive applicants/members to allow for rules engine determination and enrollment

  10. Putting the Pieces Together to Serve Members Indian Health – Tribal • Leveraging current eligibility resources • SoonerCare determination required before accessing Contract Health Services funds. Community Partners • Everyone's a partner – any organization with internet and a willingness to assist Oklahomans.

  11. Considerations for Board • Ground work laid for future programs: • Insure Oklahoma, • Breast and Cervical Cancer • Health Reform initiatives • Expansion of FPL • Categorical relationship removal • Coordinates well with Health Information Exchange

  12. Lessons Learned • It takes a village • Design tools – wireframe application utilized for focus groups and application flow • A variety of approaches are critical • Build partnerships and keep them alive

  13. For More Information . . . • Contacts Richard Evans, Manager Eligibility Automation and Data Integrity 405.522.7101 - Richard.Evans@okhca.org Derek Lieser , Project Manager Planning and Development 405.522.7376 - Derek.Lieser@okhca.org

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