Oklahoma Health Care Authority: Online Enrollment (Easy as 1-2-3)

41,742 views

Published on

Published in: Health & Medicine
  • Just trying to renew my sons sooner care insurance
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Oklahoma Health Care Authority: Online Enrollment (Easy as 1-2-3)

  1. 1. Online Enrollment (Easy as 1-2-3) www. my SoonerCare.org Oklahoma Health Care Authority
  2. 2. What’s In a Name? What Is Online Enrollment? Comprehensive Web App For For State Sponsored Medical Programs Streamlines Policy, Processes, and Access to Services Real-time Eligibility, Enrollment, and ID Generation SoonerCare <ul><li>Launched: Sept. 7, 2010 - www.MySoonercare.org </li></ul><ul><li>Concept submitted to CMS in summer of 2007. </li></ul><ul><li>Work began after approval December 2007 </li></ul>
  3. 3. <ul><li>Over 500,000 Non-Insured Oklahomans </li></ul><ul><li>22% Of Uninsured Live In Rural Areas </li></ul><ul><li>- Limited access to OKDHS offices </li></ul><ul><li>Oklahomans Are Unsure If They Qualify </li></ul><ul><li>- It’s Healthcare, Not Welfare </li></ul><ul><li>- Private, real-time determination available 24/7 </li></ul><ul><li>Enrollment Process is Broken </li></ul><ul><li>- Dependency upon Legacy Mainframe </li></ul><ul><li>- Client Numbering </li></ul><ul><li>- Streamline enrollment and verification </li></ul><ul><li>- Intuitive application with editing controls </li></ul>Why Did We Do It?
  4. 4. 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
  5. 5. How Does It Work? Apply or Renew Online Real-time Decision & Enrollment Data Verification
  6. 6. Was State Policy Affected? Date Specific Eligibility Rolling Redetermination Changing the Way We Do Business
  7. 7. Why No Wrong Door? Notification of DOS NODOS App Behavioral Health DMH App Newborn Registration e-NB-1 App Paper Application Home View Agency View Applying at Home Computer or Community Partner Applying at Agency Partner Completing Paper Form Mail to HP For Scanning
  8. 8. Real Time Reply Mail to HP Rules Engine Yes No Client Numbering Paper Form Home View Agency View Letters Notices & ID Cards Scan and Data Entry MMIS Eligibility Recipient Denial Reason / Member Denial Letter NODOS (hold date) Behavioral Health App (ID)
  9. 9. <ul><li>Initial Phase </li></ul><ul><ul><ul><li>Children, Pregnancy, Families </li></ul></ul></ul><ul><ul><ul><li>Family Planning waiver </li></ul></ul></ul><ul><ul><ul><li>Behavioral Health Services </li></ul></ul></ul>Who is Affected? <ul><li>Phase II </li></ul><ul><ul><ul><li>Insure Oklahoma (Premium Asst) </li></ul></ul></ul><ul><ul><ul><li>Oklahoma Cares (BCC) </li></ul></ul></ul>
  10. 10. What Got Better? NEW WAY Real Time Eligibility Policy Uniformly Applied Medical Home - Enrollment Streamline Business Process Normalized data Apply 24hrs/7days Available: M/F, 8am-5pm 20-30 Days For Results Individual Policy Interpret No Primary Care Provider Process Differs By County Imprecise data OLD WAY
  11. 11. What About Verifications? SSN OK State Dept of Health (OSDH) Pregnancy Social Security Administration Income Citizenship OSDH, Electronic Verification of Vital Events, Systematic Alien Verification for Entitlements OK Employment Securities Commission (OESC)
  12. 12. <ul><li>NO WRONG DOOR </li></ul>How Does One Apply? Paper Application Home View Agency View Applying at Home Computer or Community Partner Applying at Agency Partner Completing Paper Form Mail to HP For Scanning
  13. 13. Programs Affected What is Needed FAQ’s Income Guidelines SoonerCare SoonerPlan Behavioral Health Review Benefits Check Status Update Information At-Home & Community Partner Options Tell Me More Apply Now Manage Account
  14. 15. Screen shot of first page of home application
  15. 16. Pregnancy Citizenship Identity Certification Ending Domestic Violence Review Benefits Check Status Update Information Agency Partner Options SoonerCare SoonerPlan Behavioral Health View/Update Verifications Eligibility Alerts Manage Member Search & Submit
  16. 17. Partner Agency Log In
  17. 19. Agency Partner Verification Screen
  18. 20. Paper Application Mail In Paper Scan and Data Entry Rules Engine Letter-Notices-ID
  19. 22. Electronic Notification of DOS Jan 6 By Jan 21 ELIGIBILITY SUBSYSTEM (Holds Jan 1) RULES ENGINE Clerk Enters NODOS ( within 5 days of DOS ) Submitted Electronic or Received Paper Application Full Application “Submitted By” Range DOS Range 5 Days 15 Days JAN 1 Certification Date NODOS NODOS in Last 15 Days? Cert Date Received By Yes
  20. 23. Date Of Service Notification OK….Something like a timeline that shows a person comes in to emergency room and a couple of days later a hospital staff member fills out a NODOS application and then getting an application within 15 days and going back to 5 days prior to NODOS receipt.
  21. 24. Screen shot of NODOS screen
  22. 25. Mental Health Enrollment OK….Something like a timeline that shows a person comes in to emergency room and a couple of days later a hospital staff member fills out a NODOS application and then getting an application within 15 days and going back to 5 days prior to NODOS receipt.
  23. 26. Screen shot of DMH Application screen
  24. 27. Did We Learn Any Lessons? <ul><li>It Takes A Village </li></ul><ul><li>Design Tool – Wireframe </li></ul><ul><ul><li>Application </li></ul></ul><ul><ul><li>Focus Groups/Application Flow </li></ul></ul><ul><li>A Variety of Approaches Are Critical </li></ul><ul><li>Build Partnerships - Keep Them Alive </li></ul>As A Matter of Fact…We Did!
  25. 28. <ul><li>Phase II </li></ul><ul><ul><ul><li>Insure Oklahoma (Premium Asst) </li></ul></ul></ul><ul><ul><ul><li>Oklahoma Cares (BCC) </li></ul></ul></ul><ul><li>Phases III, IV, V,… </li></ul><ul><ul><ul><li>Interfaces with other Agencies and Programs </li></ul></ul></ul><ul><li>Health Insurance Exchange </li></ul><ul><ul><ul><li>Partnership with OK. Insurance Department </li></ul></ul></ul><ul><li>Health Care Reform Changes </li></ul><ul><ul><ul><li>Rules Engine Modifications </li></ul></ul></ul>Where Do We Go From Here?
  26. 29. <ul><li>Richard Evans </li></ul><ul><li>Eligibility Unit Manager </li></ul><ul><li>Oklahoma Healthcare Authority </li></ul><ul><li>405-522-7101 </li></ul><ul><li>[email_address] </li></ul>Questions???

×