AGENCY VIEW USER MANUAL

Transcription

1 OKLAHOMA HEALTH CARE AUTHORITY HEALTH CARE AUTHORITY ONLINE ENROLLMENT AGENCY VIEW USER MANUAL

2 Table of Contents 1.0 Introduction and Purpose of Manual Logging on to the System Logon Member/Applicant Search Searching for Existing Members Member Profile Members Tab Contact Information Employment Income Other Income Child Care Absent Parents Health Insurance Application Summary and Items Requiring Attention Selecting Primary Care Provider Printing Results of Application Updating Verification Status View/Update Benefits View/Update Primary Care Provider References Program Guidelines Frequently Asked Questions Glossary... 50

3 1.0 Introduction and Purpose of Manual Online Enrollment was implemented so that there is not just one way to apply for SoonerCare Health Benefits. Prior to implementation of Online Enrollment you could only apply by going to an Oklahoma Department of Human Services (OKDHS) county office or by mailing a paper application to an OKDHS office. Online Enrollment accepts applications over the internet for those applying for SoonerCare, SoonerPlan, Soon To Be Sooners, and DMH Behavioral Health programs (more programs will be added later). Eligibility is determined real-time, so that the person applying knows right away who is eligible, what they are eligible for, what their member ID is, and if there is any documentation they need to mail in. There are several ways for people to apply or make changes to their case information. 1. A home user can log on to the mysoonercare.org web site and submit an application or make changes to an existing application. They will get their results back right a way, telling them if they are eligible or not. 2. An individual can go to an Oklahoma State Heath Department (OSHD) office, an Oklahoma Department of Human Services (OKDHS) office, or a tribal clinic and get assistance with filling out an application online. They may also fill out or drop off a paper application. 3. An individual can print a paper application from the mysoonercare.org website and mail it to the Central Eligibility Unit. There are 2 different web app views that can be used to submit applications (new and changes). 1. Home View This will be used by individuals wanting to apply by themselves. It can be accessed from the mysoonercare.org website. The user can submit a new application. If they create a user ID and password, they can save an application as they are working on it or later retrieve a saved application or their last submitted application. When they retrieve a saved or their last submitted application, they can make changes and resubmit. Unless the home user is just changing their phone number, authorized rep, or requesting a new PCP, they must verify all information is correct and resubmit the application. This will create a new application, determine eligibility again, and give them another 12 months of eligibility if they are eligible. 2. Agency View An Agency worker can key a new application or pull up an existing saved or submitted application. They can make changes to an existing application and send it back through the eligibility determination process to determine who is eligible and who is not. If found eligible, they will be given another 12 month period of eligibility. On both the home view and agency view, a results page will be displayed after the application has been submitted. It will contain the following types of information. For each person who was approved, the following is listed: o all programs they are eligible for and the effective date - 3 -

4 o any documentation they must send in and the due date o their member Id o if they selected a Primary Care Physician (PCP), the doctor s name, and phone number For each person who was not approved, the following is listed: o Explanation of why they were not approved If it was determined that any one on the application may be eligible for some other state or federal services, those services are listed and will contain information about the service and who they need to contact for more information. Each time an application is processed to determine eligibility; a letter is mailed to the payee telling them the current status of their application. There are times when an application is systematically reprocessed, rather than by human intervention. When this happens, eligibility can change for a person. This is why the Case Status letter is always sent out after the application is processed. 2.0 Logging on to the System 2.1 Logon The first step is to log on. Select what agency you work for. Next select your office location. If it is not listed choose None

5 3.0 Member/Applicant Search You will now be directed to the search page which allows you to search for a person using a variety of methods. This is another feature of the Agency View application agency users may locate and update any application in the system on behalf of their clients where a home user may only view data he has entered about his family. You should always search for an existing application for the family first. If one is found and contains the same adults, it should be selected and updated with any new/changed information. This will save you some typing! If the family cannot be found or the application has different adults, then this would be a new application. Click on the add a new applicant button below your search results

6 3.1 Searching for Existing Members For members or applicants that need to reapply or already have open benefits there are five different search options. 1. Application Tracking Number (ATN): The ATN is a number used to track a specific application. Each time a client reapplies they are given an ATN. It does not change if a client is just making changes to an ongoing application. 2. Member ID: This is the member identification number assigned by OHCA to current or former members. Depending on when the member applied they may have either a DHS assigned number (starts with a number) or an OHCA assigned number (starts with a letter). Whichever number they are assigned first and are known on MMIS, will be their ID number. 3. Case Number: The case number is used to identify a family unit, by payee and spouse. Each time the same payee and spouse apply together, their new ATN will have the same case number. It doesn t matter which is the payee or which is the spouse, as long as it is the same two, they will use the same case number. If there is no spouse, then it just uses the payee. As long as the payee is always that same payee, it will be the same case number. DHS assigned case numbers start with a letter, while OHCA assigned case numbers start with a number

7 4. Name and Date of Birth: When searching by client name you must also have the member s date of birth. 5. Social Security Number and Date of Birth: When searching by Social Security number you must also have the member s date of birth. Search Return After entering the search criteria you will get a list of results. If the person you are searching for is not listed, you may Search Again or Add Applicant. If the - 7 -

8 application has changes pending (Application State of Saved ), and you select an earlier version of the application to work on, the saved version of the application will be deleted and all updates pending on it will be lost. This shows the search results for the same member ID after the saved ATN in the previous screenshot was completed. The old ATN now shows closed, and a new ATN is opened. 4.0 Member Profile After selecting the appropriate member and application, that application will be opened with all of the application information organized into separate tabs. These tabs will only appear in the agency view of the application

9 Members: This tab allows the user to add, remove, or modify family members. If this is a new application, then a blank form is displayed for the user to start entering the family s data. Examples of this data would be names, date of birth, etc. Contacts: This tab allows the user to add or modify the information about how to contact the family. If this is a new application, a blank form is displayed for data entry. You may also add an authorized representative on this tab. Employment: This tab allows the user to add, remove, or modify employment income. If this is a new application, a blank form is displayed if the user indicates there is employment income; if there are adult family members with income, the jobs/businesses are displayed in collapsed mode. Other Income: This tab allows the user to add, remove, or modify non-employment income. Do not include things such as food stamps, HUD and/or OHFA housing assistance/utility payments, or energy assistance payments (LiHeap or ECAP). Child Care: This tab allows the user to add, remove, or modify information about childcare expenses paid by the family. If this is a new application, a blank form is displayed if the user indicates there are childcare expenses. Absent Parents: This tab allows the user to add, remove, or modify absent parent information. Parents who do not live with their children are considered to be absent parents. Health Insurance: This tab allows the user to add, remove, or modify health insurance information. If this is a new application, a blank form is displayed if the user indicates there are family members with insurance. Comments: This tab allows the user to view all comments and add comments. For each comment entered, the user must also choose what category it should be in, based on what the comment is about. For example, a note about someone reporting the loss of a job would go in the Employment category of Comments. Summary: This tab summarizes the information gathered on all other tabs. It provides an overview of all the information on the application and is presented in the same order as the tabs going across the top of the application. Within each section is a link to go edit - 9 -

10 that section. You may also edit the section by clicking on the corresponding tab at the top. In the area directly above the tabs, alerts may appear. They are there to advise you of important case status information such as: benefits are about to expire domestic violence outstanding documentation due pregnancy past due To the right of the tabs, there are links broken into two sections I want to and References. I want to are a series of quick links that take you directly to a section that you may need to review or update on an already completed application while the References section provides links that offer Medicaid program guidelines, FAQ s, and a glossary

11 One advantage of the agency view over the home view is that you can move from tab to tab as needed. However we STRONGLY advise that as you are working on a new application or a review, that you start with the members tab and continue working each tab left to right. This will help prevent errors from occurring and important data being overlooked. 4.1 Members Tab If this is a new client you will begin by Add person. If this is an ongoing client you need select the newest information that you have found in your search results. After selecting the appropriate member and application you will be directed to the members tab. From this tab you can modify the demographics information by selecting the person you want to modify

12 Once you have selected Add Person, you will be directed to a screen to enter the new member s information. If this is new case, start by entering the adults first, beginning with the adult who will be the payee on the case. Next, enter the children Some fields will require additional information. Gender is one example

13 If the client is female and over age 10, you will be asked if she is pregnant. If yes, then you will be asked for the due date and the number of babies expected. Use the same date for the due date and the pregnancy end date. Another example is when you select Native American under the Race section. You will be required to select the applicant s specific tribe and give other information about tribal enrollment. If you select Other as the Primary Tribal Name, you will be required to enter that Tribal name in the box below

14 Additionally, if you indicate the applicant is not a U.S. citizen under the Residency and Citizenship section, additional information will be required. You will need to enter the member s alien status. If the client has a status of Undocumented or Illegal or Alien here on a temporary basis only then no other information is required. Any other selection requires the members Alien Registration Number and Date of Entry. You will also be asked how each member is related. It will start by asking for each person s relationship to the payee. If there is another adult besides the payee, it will then ask for the member s relationship to that adult. To remove a person, check the "Remove this person" box for that person. You will be asked to select a reason and effective date. Select the appropriate removal reason and enter the date the client left the home as the effective date

15 If you remove the payee, you will be required to select another adult as the payee. If there are no other adults on the case you must either add another adult or close the case. In order to close a case, please update each person on it to show that they have been removed. If there are children in need of coverage, then the adult who is now responsible for their care will have to apply on their behalf in order to determine their continued eligibility for medical coverage. To view or reactivate an individual who previously was removed from the household, select the individual's name from the "Former Household Members" list located on the right. After you have selected a member you may view their information and then choose to reactivate them by selecting Reactivate Household Member. Once a member is reactivated their information may be updated

16 4.2 Contact Information This tab contains the households contact information. If the household chose an authorized representative this is where that representative is listed. The only required contact information is an address and preferred language. We require both a physical and a mailing address. If they are the same, then simply check the box next to mailing address indicating Same as Residence

17 Once you have updated the Contacts tab a box will pop up if the system could not match the address exactly. It will give you options that it has found. Select the address that most correctly represents the clients address

18 Below that is the additional contact information such as phone numbers, address, and authorized representative. Though this information is optional, we encourage it to be collected. An authorized representative is a person over age 18 who the household grants permission to act on their behalf. This can be useful if all adults work during the day and may need someone else to call OHCA on their behalf

19 4.3 Employment Income You can add, remove, or update employment income from this tab. When you choose to add income, simply hit Add income and an empty set of fields will appear. Select the person who is employed, list the employer, and list the employer s contact information if it is available. Next, enter the GROSS (pre-tax) earnings of the member and the frequency with which they are paid. Lastly, indicate if the income is self-employment income

20 To add another employer, click the Add income link again. You can enter multiple employers for one person if needed. To remove employment income, select the person who is no longer employed and check the Remove this income box for the employer that is no longer valid. It will be removed once you update the case

21 4.4 Other Income This tab allows you to add, remove, and update the household s other income. This is any income that does not come from a job, such as Social Security, rental income, child support, unemployment income, or help from friends. To add other income you will hit Add Income. You will then get a blank set of fields for you to complete. Select which person receives the income, what type of income it is, and how often they receive it

22 Note: List child support under the child for whom it is paid, not under the parent. Also do not include income such as food stamps, housing assistance (HUD or OHFA) payments, or energy assistance payments. To remove other income, simply uncheck the box next to the income that is no longer being received

23 You may also update the income amounts and frequency of pay. 4.5 Child Care This tab allows you to add, remove, and update the household s child care expenses. To add childcare expenses, select the correct child, add the whole dollar amount paid, and then the pay frequency. To remove the expense, uncheck that child

24 4.6 Absent Parents This tab allows you to add, remove, and review absent parent information. If there are absent parents already added to the case they will appear here. They can be updated, removed, and added back to the case. To update information on an existing absent parent, select the person you want to update. Once you have selected an absent parent you may update their demographics, their legal status, and/or remove them from the case if necessary

25 To add a new absent parent, click Add absent parent. You will then get a blank set of fields to enter the absent parents legal status and demographic information

26 Under the Support Services section there is an option that allows you to enter additional absent parent information. For each absent parent that is entered you will need to also enter their legal status. To remove an absent parent from the case check Remove this absent parent under the appropriate absent parent. You will be asked to enter the reason and the effective date

27 If you need to add a previously added absent parent back to the case, select that person from the Former Absent Parents list then select Reactivate Absent Parent. You will then be able to update their demographic and contact information

28 4.7 Health Insurance This tab allows the user to add, remove, and modify health insurance information. If this is a new application and the user indicates there are family members with insurance, a blank form is displayed for data entry. To add insurance to the case, select Add more insurance. You will then get a set of fields asking for the type of insurance. As you complete these fields you will get additional fields asking for more information until all required fields are completed. When you begin entering the company name the system will begin listing companies known to the system that matches the information that you are entering

29 There are two ways to remove third party insurance from a case. If you have not yet submitted the application you will have the option of Delete this insurance. Once the application has been submitted you will have to use the End this insurance option. COMMENTS This tab allows you to add and view comments

30 The comments may be sorted by date, category, or both. You may also add comments by selecting the Add another comment link at the bottom of the comments. By default, it will create the comment with the comment heading of the tab that you are currently working. For example, if you are working on the Members tab and you select Add another comment using the toolbar on the right, it will automatically add your comment under the Members category. If you are working in the Comments section, you will have to choose the category

31 5.0 Application Summary and Items Requiring Attention SUMMARY This tab summarizes all of the information gathered on all other tabs. From here you can see all information that has been completed on the application, make corrections as needed, see what changes need to be made to complete the application, and submit the completed application. If you see! Items requiring your attention that means there are some issues you need to address before the application is considered complete and can be submitted. To see the problem areas click on the Orange dialogue box. It will open and show the tabs that have incomplete or invalid information

32 If there are more than a few errors, they will be shown in a compressed list as shown above. If there are just a few errors, they will be shown in their entirety like in the screen below. To see the more detailed view of the errors on the compressed list, select Show all errors. You will then see a detailed list of the errors that are preventing you from completing the application. If you then choose the blue page link on the left or the tab that is indicated, it will take you directly to the problem area that needs to be corrected

33 If you select Contacts you will be taken to the Contacts tab with the errors highlighted. After all errors in this tab have been addressed, continue by correcting the errors in the other tabs

34 Once the errors have been corrected, you can click on Check for Errors again to make sure that everything has been resolved. The Check for Errors button is ONLY available on this Summary page. It must be used and all errors corrected before you will be allowed to continue

35 At this point if you are processing a physical application, you will need to enter the media type: paper, faxed, or MSMA-5. You will also need to enter the date you received the application as the application date. If you are completing an online application, this will be done for you. When the application is completed and no errors are found you will need to review the Rights and Responsibilities with the client. If this is an application, whether the person has previously had SoonerCare or not, you must review the Rights and Responsibilities with that person. Once the application is submitted, eligibility will be determined for all persons on the case. Once the user selects "Submit Application" he will not be able to make modifications to what he has entered until the application process is complete. If there is at least one person who is eligible and whose citizenship or identity has not been verified, the user is directed to the "Declare Citizenship" screen. This screen will ask for more detailed information in order to attempt an automated citizenship match

36 Identity verification will also need to be entered here at this time. If the member is under 16, a parent or legal guardian can complete a Statement of Identity of a Child. If the member is over 16 or the person completing the application is not the member s parent or legal guardian, then a recognized form of verification will have to be submitted

37 6.0 Selecting Primary Care Provider If there is at least one person who is eligible (and all citizenship and identity information has either been entered or already verified), the user will be directed to select a Primary Care Provider (PCP). If the member has not had a PCP for SoonerCare recently, a search tool with several different search options will appear. You can search by location, name, or provider ID. If searching by location you have several options to choose from. You can search by distance from home, City/State, ZIP code, or county

38 You can also search by name. If you do a name search you must enter both the first and last name. The third search option is to use the Provider ID number

39 If any member had a previously assigned PCP, then you will be asked to either verify that selection or to make a new selection for each eligible member. After you have selected PCPs for all eligible members, you will be directed to the results page. It includes the ATN, the eligibility results for each person in the household, the reasons why someone might have been denied, and any documentation that must be submitted. The names are displayed sorted by eligibility - approved/eligible, temporary, and denied. For those eligible members, their ID, program, PCP, and effective date are displayed

40 If anyone in the family may be eligible for other programs, the program is listed and may be clicked for more information. If no one in the household is eligible, it will skip the Declare Citizenship and PCP search screens - the user will be directed to the "Results" screen. 7.0 Printing Results of Application At this point the application is complete and the results can be printed. No matter what the results are, this page should be printed and given to the person who applied. It contains information they will need to make inquiries about their application or to schedule a medical appointment. The Print cover sheet button only displays if there are outstanding documents that need to be submitted. If the member needs to provide additional verification, it is very important that they attach this cover sheet to the verification when they return it. This cover sheet is coded to identify the client s specific case and to make sure their documentation is quickly and correctly entered into their case record. This faster processing can help prevent breaks in eligibility from occurring

41 I want to The I want to section is a set of quick links located on the right side of the agency view application. They allow you to quickly view and update member verification, benefit status, and PCP. If the application has not been submitted and approved the View/update Primary Care Provider link will not be displayed. Add Comment When clicking Add comment, a dialogue box will pop up for you to enter your comment. You will have to select the comment category type

42 8.0 Updating Verification Status View/update Verification Status If a client returns the verification to you instead of the mailing center, you may be able to document that on their case. Go to the I want to toolbar and select View/update verification status

43 It is important to note that if you (your agency) will not be keeping a copy of the documents provided by the member, then you will not be able to update the member s application with their verification. In that instance, the documents will have to be sent to Oklahoma Health Care Authority PO Box Oklahoma City, OK for processing and storage. When you select View/update verification status you will see a list of all members that need to provide some form of verification. It will be broken down by each individual member and the type of verification needed. In the example below you can see that each household member needs to provide citizenship verification. As members provide verification you can go in and update their verification status. Only update the status of members that provide verification. If the verification is not acceptable, choose Not met and enter the date the verification was received. If it is acceptable select Met, enter the date received, and the document type if required. In the example below, Susan has provided acceptable proof of verification while Susan has provided unacceptable Social Security verification. Be sure to update the Comments section as you update the Verification section. This can help prevent confusion when a member calls about verification that they have provided. If some form of verification is not acceptable please explain why in the appropriate Comment section

44 9.0 View/Update Benefits From here you can view the details of a member s eligibility, such as when each person s eligibility is going to end

45 This screen is also used to end, suspend, or reinstate a person s benefits. Select the person whose benefits need updated by clicking on that person s name. End Benefits: An example of when you need to END someone s benefits would be when a person told you that their teenager had moved out to live with a grandparent. That teenager s eligibility would need to be ended, so that the grandparent could apply on his behalf

46 Suspend Benefits: We anticipate that OHCA and Central Eligibility Unit staff will usually be the ones using this feature of the application. An example of why someone s eligibility might be suspended would be if we received word that the person had a change in circumstances that would affect their eligibility. If we have not been able to contact them by telephone OHCA/CEU would suspend their benefits and send a letter indicating the reason. Suspensions take effect 10 days in the future if the person does not supply the needed items. If you suspend benefits you will need to elect what documentation is needed and enter the text to be sent in the suspension letter

47 Reinstatement: An example of a reinstatement would be where a person mailed in documentation that arrived on the due date but was not processed until the next business day. Since the information was received by the due date, the person is reinstated to give them eligibility as if the deadline had not been missed. If you need to reinstate benefits select the reason and the start date. If you are unsure of the start date, please call the Oklahoma Health Care Authority toll-free at and we will assist you in making that determination

48 10.0 View/Update Primary Care Provider This link will only appear if there is a member currently eligible. This section allows you to view the member s current PCP selection, and/or change the member s selection. You can select different PCP s for each eligible member, or you can choose the same one for everyone

49 11.0 References 11.1 Program Guidelines This section will list the general program requirements such as income standards, along with citizenship and identity requirements Frequently Asked Questions This section will address some of the more frequently asked questions

50 11.3 Glossary This section will provide definitions of some commonly used terms

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