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C-IV CalHEERS Interface

C-IV CalHEERS Interface. December 12, 2013. Overview.

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C-IV CalHEERS Interface

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  1. C-IV CalHEERSInterface 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.

  3. C-IV and CalHEERS Communication Flow

  4. Key Terms

  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.

  6. Access Channel Flow for CalHEERSand the Federal Hub CalHEERS Access Channel Customer Data Income, SSN, Tax Filer, etc. Federal Hub CalHEERS e-Verification for Customer Info Fed Hub Access Channel

  7. Access Channel Flow for C-IVand CalHEERS C-IV Access Channel EDR DER DS C-IV CalHEERS Images/NOAs CalHEERS Access Channel DER DS

  8. January 2014 C-IV CalHEERS

  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

  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.

  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.

  12. MAGI Referral Search Navigation Path-Case Info>e-Tools>Magi

  13. MAGI Referral Search Case Summary MAGI Referral Detail Page

  14. MAGI Referral Detail • Status Options: • Received • In Process • Reviewed • Complete You can navigate to the MAGI Person Detail page by clicking on the person hyperlink.

  15. Referral Status • Types of Statuses: • Pending • Ineligible • Eligible • Conditionally Eligible

  16. MAGI Person Detail Page

  17. Tax Filer Information

  18. Verification

  19. View Differences

  20. Questions

  21. Case Summary

  22. Case Summary-New Role Navigation-Case Summary>Applicable Program>View Details>Admin Role

  23. Admin Role-CEC

  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

  25. Individual Demographics

  26. Indian Tribes

  27. Ethnic Origin

  28. Customer Options 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.

  29. Maintain Verifications 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

  30. Verification Consent 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

  31. Full Medi-Cal Hierarchy 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

  32. Tax Household Tax Household List page – Every person in the household must be associated to a tax filing status. Navigation Path: Customer Information>Financial > Tax Household

  33. Tax Household Detail 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

  34. Validation Page Sample – Validation received when attempting to input a duplicate tax household record.

  35. Two Tax Filers We have Grace and Harold Barney who are a married couple filing jointly. Grace is the primary tax filer.

  36. Primary Tax filer

  37. Requesting MAGI Determination 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.

  38. Requesting MAGI Determination

  39. More About the MAGIDetermination Page

  40. Life Change Event

  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.

  42. Message Center Double click the globe icon to open the message center.

  43. Message Center

  44. Message Center

  45. MAGI Determination Summary

  46. MAGI Determination Detail

  47. Questions

  48. Running EDBC Error Message

  49. EDBC Results

  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

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