cms quick reference guide for issuers · 2020. 8. 7. · cms quick reference guide for issuers...

CMS Quick Reference Guide for Issuers

Managing Casework in the Health

Insurance Casework System

(HICS)

Prepared by:

Cognosante LLC

3110 Fairview Park Dr, Suite 800 | Falls Church, VA 22042

Version 4.0

October 15, 2020

AOPP-7.2.720 CMS Quick Reference Guide for Issuers

Managing Casework in the Health Insurance Casework System (HICS)

Version 4.0

October 15, 2020

Proprietary and Confidential – Rev 3.0

©Cognosante LLC, 2020 – All Rights Reserved

Page i

Revision History

Version Date Revision Owner Description of Changes

4.0 10/15/2020 Cognosante ► Added Section 1.2.6, Plan Request ► Updated Exhibit 7, Case Information Page

Attachments Tab ► Added Exhibit 8, Plan Request Tab ► Updated Exhibit 9, Case Information Page Resolution

Tab

3.0 08/13/2020 Cognosante Added ISO numbering to the header

2.0 04/22/2020 Cognosante Updated Exhibits 1 through 14

1.0 09/06/2019 Cognosante Baseline



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Table of Contents

1.0 Introduction ....................................................................................................................................... 1

1.1 Purpose/Scope ......................................................................................................................... 1

1.2 Managing Casework in HICS .................................................................................................. 1

1.2.1 Access HICS ............................................................................................................... 1

1.2.2 Upload Casework ........................................................................................................ 3

1.2.3 Search for Cases ......................................................................................................... 4

1.2.4 Upload and View Attachments ................................................................................... 6

1.2.5 View Case History of Caseworker Assignments ........................................................ 7

1.2.6 Plan Request ............................................................................................................... 7

1.2.7 Resolve (Close) Cases ................................................................................................ 9

1.2.8 Data Extracts (Download Case Data) ....................................................................... 11

1.2.9 View Reports ............................................................................................................ 13

Appendix A. HICS Categories and Subcategories ............................................................................. 16

List of Exhibits

Exhibit 1: HICS Security Warning ............................................................................................................... 1

Exhibit 2: HICS Home Page ......................................................................................................................... 2

Exhibit 3: Casework Tracking Start Page ..................................................................................................... 3

Exhibit 4: Casework Upload Page ................................................................................................................ 4

Exhibit 5: HICS Search Page ........................................................................................................................ 5

Exhibit 6: HICS Search Results Page ........................................................................................................... 6

Exhibit 7: Case Information Page Attachments Tab ..................................................................................... 7

Exhibit 8: Plan Request Tab ......................................................................................................................... 8

Exhibit 9: Case Information Page Resolution Tab ...................................................................................... 10

Exhibit 10: Data Extract Page ..................................................................................................................... 11

Exhibit 11: Data Extract Criteria Selection – Monthly ............................................................................... 12

Exhibit 12: Data Extract Criteria Selection – Open .................................................................................... 13

Exhibit 13: Select Report Page ................................................................................................................... 14

Exhibit 14: Report Criteria Selection Page ................................................................................................. 14

Exhibit 15: Issuer Aging Report ................................................................................................................. 15

List of Tables

Table 1: Category ........................................................................................................................................ 16

Table 2: Plan and Issuer Concern Subcategories ........................................................................................ 16



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1.0 Introduction

1.1 Purpose/Scope

The Health Insurance Casework System (HICS) provides access to unresolved and resolved cases that

originate from the Health Insurance Marketplace Call Center and other sources. It enables the user to add,

edit, search, and resolve cases, and download case files and reports.

1.2 Managing Casework in HICS

1.2.1 Access HICS

Use the following steps to access HICS:

1. Access the website at: https://hics.cms.gov.

2. Enter Username and Password and click Login.

3. A popup security window as shown in Exhibit 1 will appear warning users that this system is for

government-authorized use only. Users must read, agree, and click Confirm to continue to login.

Exhibit 1: HICS Security Warning

4. The HICS Home page will display as shown in Exhibit 3. Click Enter Casework Tracking.

https://hics.cms.gov/



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Exhibit 2: HICS Home Page

5. The user will advance to the Casework Tracking Start Page shown in Exhibit 3.



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Exhibit 3: Casework Tracking Start Page

1.2.2 Upload Casework

The Casework Upload function enables users to upload casework files.

1. On the Casework Tracking Start page, select Casework Upload from the left menu.

2. On the Casework Upload page, use the table shown in Exhibit 4 as a guide for creating the case file.

NOTE: Files must have a .txt extension.



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Exhibit 4: Casework Upload Page

3. Click Choose File to select the file for upload.

4. Click Upload.

1.2.3 Search for Cases

The Search Case function offers two options for searching for a case within the system: search by case

ID(s) or search by specific case information as shown in Exhibit 5.

1. On the Casework Tracking Start page, click Search Case in the left menu.

2. On the HICS Search page, enter Case IDs (Option 1) or other search criteria (Option 2).

a. Search case with Option 1:

i. Provide the case number(s) in Case ID field.

NOTE: Multiple Case IDs can be entered when separated by a comma.

b. Search case with Option 2:

i. Complete the intended data search field and/or combination of data fields.

NOTE: If a user selects a state, the search will retrieve all cases that have issuers, consumers,

and contacts identified with the state.

NOTE: The Case Status drop-down is set to “Open” by default. Users will need to select the

drop-down for “Both” if they want to review all cases associated with their search

parameters.



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Exhibit 5: HICS Search Page



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3. Click the Search button. The HICS Search Results page will display cases matching the parameters

entered as shown in Exhibit 6.

NOTE: There is a 300-case limit for search results.

Exhibit 6: HICS Search Results Page

4. Click the Case ID link for details about a specific case.

1.2.4 Upload and View Attachments

The Attachments function as shown in Exhibit 7 enables users to attach and view relevant documents to

specific cases.

1. Use the Search Case function to find a case that requires an attachment, or to view the attachment for

a case.

2. Click the Case ID link.

3. On the Add/Edit Case page, click the Attachments tab at the top. Any attachment files already

uploaded for the case will be displayed.

a. To view an attachment, click the Download button next to the file.



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Exhibit 7: Case Information Page Attachments Tab

4. To add an attachment, click Choose File and select the file to upload.

NOTE: .txt, .doc, .zip, .xls, .docx, .xlsx, .pdf, and .gif are the supported file types.

5. Provide a description of the attachment in the field provided.

6. Click Upload to attach the file to the case.

1.2.5 View Case History of Caseworker Assignments

The Case History function enables users to view the history of the caseworker and case category

assignments to a case.

1.2.6 Plan Request

The Plan Request function as shown in Exhibit 8 allows issuers to select a question for CMS, and

contractors from a pre-populated list of questions. When an issuer creates a Plan Request for a case, an

email is sent to the caseworker and a predefined contractor’s email address depending on the question

selected.



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Exhibit 8: Plan Request Tab

1. Use the Search Case function to create a Plan Request for a case.

2. Click the Case ID link

3. On the Add/Edit Case page, click the Plan Request tab at the top of the page.

4. Select an applicable question from the list.

5. In the Note section, type the reason for this Plan Request and the action needed from CMS or the

contractor. This note is a required field and must be saved along with the Plan Request. (The note will

be saved in the External Notes section in the Resolution tab.)

6. Click Save.



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1.2.7 Resolve (Close) Cases

The Resolution function as shown in Exhibit 9 enables users to enter comments, casework notes,

resolution summaries, and resolve cases. The ability to resolve a case (versus view a case) depends on the

case category and subcategory.

1. Use the Search Case function to find the case you wish to resolve.

2. Click the Case ID link.

3. On the Add/Edit Case page, click the Resolution tab at the top of the page.

4. On the Resolution page, in the Casework section, enter Casework Notes.

NOTE: Users can click Save after each note is entered to mitigate system timing out and losing what

users are typing. Once comments and casework notes have been saved, it cannot be modified or

edited, so it is best to proofread before clicking Save.



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Exhibit 9: Case Information Page Resolution Tab

5. For final resolution notes, check the Include in Resolution Summary box next to the applicable note

in the Casework section for notes you want call center representative to see. CMS users can check

multiple messages. .

NOTE: The resolution summary will be shared with the Marketplace Call Center for cases that

originated there. It is important to include all relative comments in the resolution summary to convey

a complete description of the research that led to your resolution outcome.

6. Before clicking the Resolve Case button at the bottom of the page, select an outcome from the

Outcome of Resolution dropdown menu.

7. Click the Resolve Case button.

NOTE: If required data is missing or there is an error, a red error message will display.



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8. If you must return to the Case Information tab to correct the error(s) after entering needed

information, click the Resolve Case button.

9. After data is accepted, a “Case Resolved” message will display at the top of the page.

1.2.8 Data Extracts (Download Case Data)

The Data Extracts function shown in Exhibit 10 enables certain users the ability to download different

types of HICS case data.

1. On the Casework Tracking Start page, click Data Extracts in the left menu.

2. On the Data Extract page, select the report type in the picklist, and click Next.

Exhibit 10: Data Extract Page

3. The criteria that display on the next page will vary based on whether the user selected Monthly as

shown in Exhibit 11 or Open as shown in Exhibit 12, respectively, from the previous picklist.



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Exhibit 11: Data Extract Criteria Selection – Monthly



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Exhibit 12: Data Extract Criteria Selection – Open

4. Make the appropriate selections for your requested data extract.

NOTE: To make multiple consecutive selections in a picklist, hold down the <Shift> key. To make

multiple nonconsecutive selections, hold down the <Ctrl> key.

5. Take note of the password for the Zip file available at the top of the page.

NOTE: To open the extract file, the user must enter the password.

6. Click Download.

1.2.9 View Reports

HICS enables issuers to view the Issuer Aging Report.

1. On the Casework Tracking Start page, click Reports in the left menu.

2. On the Select Report page, select the Issuer Aging Report, and click Next as shown in Exhibit 13.



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Exhibit 13: Select Report Page

3. Select the criteria to view for the report and click Next as shown in Exhibit 14.

Exhibit 14: Report Criteria Selection Page

4. Review the report, clicking links as desired to view more detail as shown in Exhibit 15.



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Exhibit 15: Issuer Aging Report

NOTE: Case age is calculated based on Issuer Assignment Date in calendar days.



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Appendix A. HICS Categories and Subcategories

Table 1: Category

Category Description

2 Plan and Issuer Concerns

Table 2: Plan and Issuer Concern Subcategories

Category Subcategory Description

2 1 Issuer Enrollment/Disenrollment

2 2 Claims Processing, Denials, Benefit Appeals

2 3 Quality of Care/Provider Fraud Allegations

2 4 Provider-Originated Issues

2 5 Coordination of Benefits

2 6 Premium Payment

2 7 Cost-Sharing

2 8 Rate Review

2 9 MLR Rebates (Retired)

2 10 Issuer Customer Service

2 11 Marketing Complaints

2 12 Agent/Broker-Initiated Compensation Issues

2 13 Access to Services/Benefits

2 15 Special Enrollment Period (Issuer Action Required)

2 16 Reinstatement/Re-enrollment Request

2 17 Cancellation/Termination Request

2 18 Medicare Overlap Issues (Retired)

2 19 Consumer Believes APTC not Awarded Properly

2 20 Auto Re-Enrollment or Renewal

2 21 Eligibility Appeals Related (OHI Use Only)

2 22 Alternative Format Request Issue

2 23 Alleged Unauthorized Enrollment

2 24 Enrollment Blocker

2 914 Other

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