Annual Enrollment Process Maps combining business process to applications then to data storage, with touchpoints diagram.

1. Wilkes-Barre
Wilkes-Barre
Location
Location
Enrollment Gold
High Level
Touchpoints
Diagram
Out & In Bound
Contact
Prospect
Prospect
n
tra
In
Onyx DB
Onyx DB
GHPONYXPDW3K1VONYXPROD60
GHPONYXPDW3K1VONYXPROD60
CLICK DB
CLICK DB
GHPCLICKDBW8K1CLICKIMRS
GHPCLICKDBW8K1CLICKIMRS
et
DialAmerica
DialAmerica
(Via Citrix)
(Via Citrix)
Web
Approval
Screens
Onyx
APP
Immediate
Prospect
Appointment
Scheduling
Status
Inquiry
Only
GIS DB
GIS DB
(GHPCLICKAPW8K1V)
(GHPCLICKAPW8K1V)
Pu
and lls new
Age
D
nt A ispatc
h
s
Info signme
nt
Prospect Info
And
Meeting Results
Agent
Agent
Assignment
Assignment
Report
Report
Off-line Client Sync
Web Service
Appointment
SMTP E-Mail
To Rep
In
Bo
u
nd
Co
nt
ac
t
Click
IMRS
Automated Scheduling
A
Rep
Rep
Web Service
Web Service
Server
Server
Contact
or
Appointment
Tower
Tower
DB
DB
Co
t
ac
nt
Contact
Int
ern
et
D
ire
ctl
y
Off-line Client
Web Service
Off-line Client
Off-line Client
(Gold Site)
(Gold Site)
Destination
Destination
RX db- External DB
RX db- External DB
Web Service pulls all EFTS info from GHPDB-Table 2, then puts into AMISYS Healthy
(PROD) Server, Table: GE_AUTO_ENROLL.
Retrieve
Plan
Info.
Web
Approval
Screens
2. Destination Rx App
Click Submit
E-Mail Process to Web
Approval Screens
GHP_DB_Table 1
s
een
Scr s
val vice
pro er
Ap eb S
W
Click
Enroll
AMISYS
AMISYS
Healthy
Healthy
EFTS
Web Service
Applications Used
1. Web Enrollment App
A
A
geisingergold.com
Broker
Broker
Retail
Retail
Groups
Groups
H
Of ard Co
Do c
p
um y
ent
s
ith
ew t
hil ec
W rosp
P
Prospect
Prospect
SOA Packet
Web Service
GE_AUTO_ENROLL
EFTS Info
EFTS Info
Flat File
Flat File
834
Web Services
This process converts 834 info into
readable form for AMISYS, then moves
info into AMISYS Healthy
BMUP
Process
GHP_DB_Table 2
Generate 834s? GHPFILEGENERATORS Programs
GHPDB
GHPDB
AMISYS
Batch
GHP File
Genereated
(pulls 834 info from File
Share Server)
834 Batch File
834 Batch File
(daily multi run)
(daily multi run)
1, Clicking on ENROLL generates original application table:
GHP_DB_Table 1
2. Clicking on SUBMITcreates replication of table 1:
GHP_DB_Table2.
On CSI SERVER
File Share Server
File Share Server
(GHLOFAXDBW8K1Transsend))
(GHLOFAXDBW8K1Transsend

2. Fall Readiness – FY2013 – Application Process
Method of Application
Prospect/Broker/
Enrollment Rep
enters in GOLD
website
Once website loads,
user chooses
ENROLL 2013 button
User chooses
ENROLL from the
Destination RX
screen iframe
Enter Zip code,
prescription
information and PCP
to get list of
available plans
Choose the correct
plan by selecting
ENROLL NOW
button
User continues
entering customer
information,
method of payment
selection
information
CMS/Extend Health
Applications
Email received from
Extend Health with
new applications in
.csv file
Email is sent to
Enrollment team for
further processing
Prospect decides to
process application
through broker
Broker loads the
GOLD website for
the prospect’s
location.
Prospect/
Broker/
Enrollment
Rep enters in
GOLD website
process
Application
Prospect decided to
process application with
field agent during Home
Meeting
Prospect receives
paper application
and fills out and
sends to GHP
Prospect dials into
one of toll-free
numbers to process
application
Field Agent selects
CREATE
ENROLLMENT
button from the
Enrollments tab of
the Offline Client
All paper
applications
received are sent to
the Enrollment
Team
Field agent
processes the
information needed
for the application
Once finished, field
agent saves the
application
Once in Wifi range,
at the end of the
day, field agent will
click the Sync button
within Offline Client
Offline Client
sync process is
started
Agent looks for
existing customer
record and
opportunity. If no
customer record,
both customer
record and
opportunity is
created. If for some
reason there is a
customer record,
but no existing
opportunity, the
agent will also
create a new
opportunity
Prospect indicates
they would like to
sign up for service
with them now
Enrollment agent
processes the
application within
the Gold website for
the prospect’s
location
Enrollment agent
finishes processing
the application, and
then continues with
the Dial
Programmed Script.
Phase
Destination RX
Destination RX
– External
Server
Web Enrollment App
Http://thehealthplan.com/gold/
CSI Server
The first table created by the Web Enrollment
App stores all original application information
during the Application creation
process(developed once application is started).
This table is then completed and replicated into
the second table(once SAVE button is selected),
which is then accessed by the Approval Screen
App
GHP
Services
DBGHP_DB
Web Enrollment App Table Depository _ 1
Agent loads the Dial
Programmed Script
and goes through
with prospect
Agent transfers call
to Enrollment Agent,
if not licensed
Once complete, user
clicks the SUBMIT
button, then exits
the site, once
confirmation page is
loaded
This system is accessed
once the user selects
the ENROLL 2013
button from the GOLD
website. An iframe is
loaded within the GOLD
web application. Once a
plan is selected, the
user selects the ENROLL
button, and then it
switched back to the
GOLD Application
Agent receives call
from prospect and
loads Onyx
Prospect/
Broker/
Enrollment
Rep enters in
GOLD website
process
Data Storage
Agent ends call with prospect and dispositions
the call
Web Enrollment App Table Depository _ 2 *Accessed
by Approval Screen App

3. Fall Readiness 2013- Enrollment Process Map
Enrollment Team
System
Approval
Screen App
GHP_DB,
Table 2
CSR pulls up the
Approval Screen
Application
CSR reviews task
list for new
enrollments that
need to be
processed
CSR will verify
all application
fields are filled
out completely,
with no errors
CSR assigns
enrollments to
themselves
Y
Does applicant
need to be
contacted?
CSR then checks
MARx system for
effective dates for
Medicare Part A, B, D
MARx
System
Multiple times per day
Daily web job
creates a batch
flat file of all
834 information
and put into file
server
CSR updates
Approval Screen app
with Medicare
information
Y
N
Amisys BATCH
runs job that
pulls 834
information
from file server
CSR updates the
status to
COMPLETE and
saves the
application
Web service pulls
information from
Approval Screen App,
then populates
information into table
GE_AUTO_ENROLL within
AMISYS HEALTH
Amisys pulls 834 information
After 834 & EFTS
processes are
finished, a job is
run called
REFRESH to match
the EFTS record
information to
834 record
information
Some letters were not setup for
automation yet. As a result,
certain letters will require a
manual generation from CG.
AMISYS
HEALTH
GHP Fileware takes all RY
Code 2B&MZ applications
and places in flat file with
EFTS information and CMS
submission information
MULTI_DAILY BATCHES FOR
CMS AND 834 VALIDATION
CMS Validation Process
Job started that
creates 834
batch error
report
TRR update is automatically sent to CMS_TRR
table within Amisys Health. CI creates a Daily
TRR report that identifies all approvals and
errors and distributes to Enrollment team
member
CSR will take the
834 batch report
and research
errors
CSR will
research
applications that
were denied
CSR will fix
errors and
resubmit with
next day’s batch
CSR will
manually
resubmit to CMS
834 Batch Error Report Process
Once TRR
update is sent,
application
approval is
triggered in
AMISYS
Y
CMS
Approval?
Member
Enrolled
AMISYS then triggers CG
Letter Generator to send
Approval Letter, if letter is
set up for automatic
generation
Enrollment rep exits
Task area, and
chooses instead to
go to link that states
“Upload vendor
application”
Using the Browse
button, Enrollment
agent uploads the
file to the Approval
Screen App
END
BMUP Process
moves data from
AMISYS BATCH to
AMISYS Health (834
& EFTS)
Ebiz Group submits the CMS flat file
to CMS using ConnectRect software
ExtendHealth emails
flat file of
applications
File server:
GHLOFAXDB
W2_TRANSS
CEND
AMISYS
BATCH
TRR report is
received
automatically into
the CMS_TRR table
within Amisys.The
Daily TRR report is
developed by IT
from the TRR
update within the
CMS_TRR table
CMS application file
is pulled from Online
Enrollment Center
Enrollment Team
convert the flat file
to Excel spreadsheet
N
CSR updates the status to
INCOMPLETE and the
applications sits in the queue
until the Medicare Eligibility is
updated in MARx system
Extend Health/CMS application files
Enrollment team
received the .csv
files and opens the
Approval Screen App
CSR will contact
applicant for needed
info, and update
Approval Screen App
Y
Eligible for
Medicare
Advantage?
CSI Server,
GHP Services
DB, GHP_DB,
Table 2
Errors?
N
CSR will update the
application with the
information
currently found
Data Storage
If letter is not setup for automatic
generation, it will need a csr to
process manually

4. Fall Readiness 2013 – Schedule a Meeting Process Flow
User
Application
s)
rica rep
ial Ame
nt for D
me
environ
in Citrix
Onyx Application Server
Onyx Application Server
n (with
catio
er appli
GHPONYXPDW3K1VONYXPROD60
yx Pow
GHPONYXPDW3K1VONYXPROD60
of On
es use
Activat
Data Storage
Agent selects
“Script” tab
Under the list
shown, Agent
chooses Gold, then
chooses “Schedule
Meeting Script”
Click IMRS dispatching is
only related to Home
Meeting and Retail 1 on1
meetings. Group meetings
are already setup into the
Onyx system, and require
no additional dispatching
required
Agent selects the
Meeting Type, and
makes sure to select
themselves under
who set
appointment
Agent confirms
Scope of
Appointment
information
Agent confirms
spousal
participation at
time of
appointment
Spouse
participation?
N
Agent records
information in
Onyx within the
meeting that the
SOA could not be
obtained for spouse
Y
Is spouse
available to read
SOA statement?
Y
N
Agent reads SOA
statement to
spouse
Agent chooses
the next
available
appointment for
the prospect, and
confirms with
prospect
Agent ends the
call and
sdispositions the
call
Click IMRS system
Click IMRS system
GHPCLICKAPW8K1V
GHPCLICKAPW8K1V
Onyx DB
Onyx DB
(GHPONYXPDW3K1V
(GHPONYXPDW3K1V
CLICK DB
CLICK DB
(GHPCLICKAPW8K1V)
(GHPCLICKAPW8K1V)
Onyx sends appt info to Click IMRS, and Click IMRS stores for dispatching 3 days before appt date **excludes all Group meetings
Agent opens up
the Onyx
opportunity/
incident within
customer record
Onyx makes a call to Click IMS to receive a list of available appointments, and click IMRS returns the information, and it displays in Onyx
Prospect requests a meeting
Prospect requests a meeting
END
Click IMRS schedules the
appointment based on
appointments in area,
and availability 3 days
before appt
Report is run on
Onyx database
that shows all
appointments for
each agent
Nightly update
runs and updates
Onyx with newly
dispatched Click
schedules
Job is run that
emails all
appointment to
reps daily...this is
done through
Exchange server
SMTP
Click IMRS
Dispatch System
Onyx database
Onyx database
Onyx application
Onyx application
(GHPONYXTAW3K1V)
(GHPONYXTAW3K1V)
Click IMRS system
Click IMRS system
GHPCLICKAPW8K1V
GHPCLICKAPW8K1V
Onyx DB
Onyx DB
(GHPONYXPDW3K1V
(GHPONYXPDW3K1V
CLICK DB
CLICK DB
(GHPCLICKAPW8K1V)
(GHPCLICKAPW8K1V)

5. Fall Readiness 2013 – Meeting Process Flows for all Meeting types
Agents
System
Presenter
arrives to
present Retail
Group Meeting
Field agent arrives
to prospect’s
house for Home
Meeting
Agent arrives
at location for
Group Meeting
Field agent logins
into Offline Client on
his laptop and begins
to start meeting
Agent takes
attendance
and records
on form
Presenter
takes
attendance
and records
on form
Does
prospect
want to
enroll?
Y
Does
prospect
want to
enroll?
Y
Paper or
Web?
Paper or
Web?
Does
prospect
want to
enroll?
Y
See
Web
applica
tion
Process
Agent
records
status of the
meeting in
Offline Client
At end of
day, Agent
opens Offline
Client and
presses the
Sync button.
A
A
N
N
Paper
Agent fills
out paper
applications,
then mails or
Agent
faxes them in
Web
records
status of
meeting and
SOA info,
then sends
toSee
GHP
Web
applica
tion
Process
Paper
Agent fills
out paper
applications,
then mails or
Agent
faxes them in
records
status of
meeting and
SOA info,
then sends
toSee
GHP
Web
applica
tion
Process
Presenter meets
with prospect
during 1 on 1 Retail
Meeting
Presenter
starts
meeting,
documenting
necessary
information
Does
prospect
want to
enroll?
Y
Data Storage
Offline Client
stores information
on local hard drive
for sync for later
time
Offline Client – Local Application
Offline Client – Local Application
Paper or
Web?
N
web
Paper
Agent fills
out paper
applications,
then mails or
Agent
faxes them in
records
Web
status of
meeting and
SOA info,
then sends
toSee
GHP
Web
applica
tion
Process
Offline Sync
Process
Thru wifi
Thru wifi
Offline Client-Local machine
Offline Client-Local machine
Onyx datbase is updated
E
n Makes a call to Onyx web services to update Onyx datbases
Makes a call to Onyx web services to update Onyx datbases
c
Onyx database
Onyx database
r
Onyx DB
Onyx DB
y
(GHPONYXPDW3K1V
(GHPONYXPDW3K1V
p
t
Takes all SO
A informat
i
ion and st
ores in To
repository
wer
o
n
Web Services Server
Web Services Server
L
i
n
e
Upload Vendor Application
Process
Customer service rep retrieves the
CMS referral flat file from CMS site
Tower Database – SOA repository
Tower Database – SOA repository
GHP APPS
GHP APPS
Email is received by
customer service rep from
Extend Health with flat file
attached
CSI Server
CSI Server
Approval screen App
Approval screen App
GHP_DB Table_2
GHP_DB Table_2
Covert flat
file to Excel
spreadsheet
Customer service rep
opens Approval
Screen app
GHP Services
DBGHP_DB
App sends information to database, which will store for 834 and EFTS processes
On Approval
Screen app,
choose
“Upload
Vendor
Applications”
On following screen,
upload excel
spreadsheet to
Approval Screen app
END
Table 2
Table 2