Online EnrollmentOnline Enrollment(Easy as 1-2-3)(Easy as 1-2-3)

www.www.mymySoonerCare.orgSoonerCare.org

Oklahoma Health Care AuthorityOklahoma Health Care Authority

What’s In a Name?What’s In a Name?

What Is Online Enrollment?ComprehensiveWeb App For

For State SponsoredMedical

Programs

Streamlines Policy,

Processes, and Access to Services

Real-time Eligibility, Enrollment,

and ID Generation

SoonerCareSoonerCare

Launched: Sept. 7, 2010 - www.MySoonercare.org Concept submitted to CMS in summer of 2007. Work began after approval December 2007

• Over 500,000 Non-Insured Oklahomans

• 22% Of Uninsured Live In Rural Areas- Limited access to OKDHS offices

• Oklahomans Are Unsure If They Qualify- It’s Healthcare, Not Welfare- Private, real-time determination available 24/7

• Enrollment Process is Broken- Dependency upon Legacy Mainframe- Client Numbering - Streamline enrollment and verification- Intuitive application with editing controls

Why Did We Do It?Why Did We Do It?

What Were the Goals?What Were the Goals?

Empower and Equip the Members

Expand Enrollment to Service Locations

Develop Multiple Program Application

Remove Barriers that Prevent Enrollment

Increase Effectiveness/Efficiency of Process

How Does It Work?How Does It Work?

Apply or RenewOnline

Real-time Decision & Enrollment

Data Verification

Was State Policy Affected?Was State Policy Affected?

Date Specific EligibilityDate Specific Eligibility

Rolling RedeterminationRolling Redetermination

Changing the Way We Do BusinessChanging the Way We Do Business

PaperApplication

Home View

Agency View

Applying at Home Computeror Community Partner

Applying at Agency Partner

Completing Paper FormMail to HP For Scanning

Why No Wrong Door?Why No Wrong Door?

Notification of DOSNotification of DOS NODOS AppNODOS App

Behavioral HealthBehavioral Health DMH AppDMH App

Newborn RegistrationNewborn Registration e-NB-1 Appe-NB-1 App

PaperForm

HomeView

AgencyView

RealTimeReply

LettersNotices &ID Cards

Scan and Data Entry

MMISEligibilityRecipient

Mail to HPMail to HP

Rules E

ngineR

ules Engine

YesYes

DenialReason

/ Member

NoNo

DenialLetter

Clien

tC

lient

Num

bering

Num

bering

NODOS(hold date)

BehavioralHealth App

(ID)

Who is Affected? Who is Affected?

•Initial Phase Children, Pregnancy, Families Family Planning waiver Behavioral Health Services

•Phase II Insure Oklahoma (Premium Asst) Oklahoma Cares (BCC)

What Got Better?What Got Better?

NEW WAYNEW WAY

Real Time EligibilityReal Time Eligibility

Policy Uniformly AppliedPolicy Uniformly Applied

Medical Home - EnrollmentMedical Home - Enrollment

Streamline Business ProcessStreamline Business Process

Normalized dataNormalized data

Apply 24hrs/7daysApply 24hrs/7daysAvailable: M/F, 8am-5pmAvailable: M/F, 8am-5pm

20-30 Days For Results20-30 Days For Results

Individual Policy InterpretIndividual Policy Interpret

No Primary Care ProviderNo Primary Care Provider

Process Differs By CountyProcess Differs By County

Imprecise dataImprecise data

OLD WAYOLD WAY

What About Verifications?What About Verifications?

SSN

OK State Dept of Health (OSDH)Pregnancy

Social Security Administration

Income

CitizenshipOSDH, Electronic Verification of

Vital Events, Systematic AlienVerification for Entitlements

OK Employment Securities Commission (OESC)

NO WRONG DOOR

How Does One Apply?How Does One Apply?

PaperApplication

Home View

Agency View

Applying at Home Computeror Community Partner

Applying at Agency Partner

Completing Paper FormMail to HP For Scanning

Programs AffectedWhat is NeededFAQ’sIncome Guidelines

SoonerCareSoonerPlanBehavioral Health

Review BenefitsCheck StatusUpdate Information

Tell Me More

Apply Now

Manage Account

At-Home & Community At-Home & Community Partner OptionsPartner Options

Screen shot of first page of home applicationScreen shot of first page of home application

PregnancyCitizenshipIdentity

Certification EndingDomestic Violence

Review BenefitsCheck StatusUpdate Information

View/UpdateVerifications

Eligibility Alerts

Manage Member

Agency Partner OptionsAgency Partner Options

Search & SubmitSoonerCareSoonerPlan Behavioral Health

Partner Agency Log InPartner Agency Log In

Agency Partner Verification ScreenAgency Partner Verification Screen

Mail In Paper

Scan and Data Entry

Rules Engine

Paper ApplicationPaper Application

Letter-Notices-ID

Electronic Notification of Electronic Notification of DOSDOS

Jan 6Jan 6

By Jan 21By Jan 21

ELIGIBILITY ELIGIBILITY SUBSYSTEMSUBSYSTEM(Holds Jan 1)(Holds Jan 1)

RULES RULES ENGINEENGINE

Clerk Enters NODOSClerk Enters NODOS((within 5 days of DOSwithin 5 days of DOS))

Submitted Electronic Submitted Electronic or Received Paper or Received Paper

ApplicationApplication

Full Application “Submitted By” RangeFull Application “Submitted By” RangeDOS RangeDOS Range

5 Days5 Days 15 Days15 Days

JAN 1JAN 1

Certification Certification DateDate

NODOSNODOS

NODOS in NODOS in

Last 15 Days?Last 15 Days?

Cert DateCert Date Received ByReceived By

YesYes

Date Of Service NotificationDate Of Service Notification

OK….Something like a timeline that shows a person OK….Something like a timeline that shows a person comes in to emergency room and a couple of days later a comes in to emergency room and a couple of days later a

hospital staff member fills out a NODOS application and hospital staff member fills out a NODOS application and then getting an application within 15 days and going then getting an application within 15 days and going

back to 5 days prior to NODOS receipt.back to 5 days prior to NODOS receipt.

Screen shot of NODOS screenScreen shot of NODOS screen

Mental Health EnrollmentMental Health Enrollment

OK….Something like a timeline that shows a person OK….Something like a timeline that shows a person comes in to emergency room and a couple of days later a comes in to emergency room and a couple of days later a

hospital staff member fills out a NODOS application and hospital staff member fills out a NODOS application and then getting an application within 15 days and going then getting an application within 15 days and going

back to 5 days prior to NODOS receipt.back to 5 days prior to NODOS receipt.

Screen shot of DMH Application screenScreen shot of DMH Application screen

Did We Learn Any Lessons?Did We Learn Any Lessons?

• It Takes A Village

• Design Tool – Wireframe Application Focus Groups/Application Flow

• A Variety of Approaches Are Critical

• Build Partnerships - Keep Them Alive

As A Matter of Fact…We Did!As A Matter of Fact…We Did!

Where Do We Go From Here?Where Do We Go From Here?

• Phase II Insure Oklahoma (Premium Asst) Oklahoma Cares (BCC)

• Phases III, IV, V,… Interfaces with other Agencies and Programs

• Health Insurance Exchange Partnership with OK. Insurance Department

• Health Care Reform Changes Rules Engine Modifications

Richard EvansRichard Evans

Eligibility Unit ManagerEligibility Unit Manager

Oklahoma Healthcare AuthorityOklahoma Healthcare Authority

405-522-7101405-522-7101

Richard.Evans@okhca.orgRichard.Evans@okhca.org

Questions???Questions???