ohca online enrollment “easy as 1-2-3 for soonercare members and partners” richard evans,...
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OHCA Online EnrollmentOHCA Online Enrollment“Easy as 1-2-3 for SoonerCare “Easy as 1-2-3 for SoonerCare
members and partners” members and partners” Richard Evans, Manager,
Eligibility Automation and Data Integrity,
OHCA
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
Web based Application
Web based Application
Streamlines policy and processes
Streamlines policy and processes
Immediate decision/
information
Immediate decision/
information
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
Why Create This?
• Eliminate barriers that prevent applications– Private, real-time determination– Online application available 24/7– Review/renewal at any time
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
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
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
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
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
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.
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
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
For More Information . . .
• Contacts
Richard Evans, Manager
Eligibility Automation and Data Integrity
405.522.7101 - [email protected]
Derek Lieser , Project Manager
Planning and Development
405.522.7376 - [email protected]