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C-IV/ CalHEERS Interface

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C-IV/ CalHEERS Interface
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C-IV/ CalHEERS Interface

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  1. C-IV/CalHEERS Interface Created by Shannon Tolbert and Valarie Rangel (Region 3) November 2013

  2. Agenda • Behind the scenes of C-IV/CalHEERS • MAGI Referrals • New Screen Shots along with functionality • Scenarios with MAGI Determinations • Miscellaneous Items and Review • Questions and Answers • Please keep your questions to the end of the training. There is a good chance that your question will be covered before the end of the training. • This is courteous to both your trainer and to your fellow trainees.

  3. Behind the Scenes of C-IV and CalHEERS communication.

  4. Batches • There are five new batch types that have been added to C-IV for CalHEERS communication. • EDR (Eligibility Determination Request) – C-IV to CalHEERS in real time. • DER (Determination Eligibility Response) – CalHEERS to C-IV in real time. • Disposition – C-IV to CalHEERS in real time. • Update – can be initiated by either system in an overnight batch process. • Image/NOA – can be initiated by either system in an overnight batch process. • The batch system ensures that the two systems can communicate changes and referrals to one another along with the resulting eligibility determinations.

  5. Batch Process Data Disposition EDR DER C-IV Images CalHEERS The Hub Updates DER e-verifications Disposition

  6. MAGI Referral Similar functionality to other e-transactions.

  7. MAGI Referral Search • This will be the starting point for the communication between C-IV and CalHEERS. • This page will alert us to the different types of referrals or change requests that have been submitted. • The functionality of this page is very similar to other e-transactions. (eICT’s, e-apps, IAT’s, etc.)

  8. MAGI Referral Search In Case Info, select e-Tools. MAGI is an option under the external agencies portion of the tasks. Follows the same functionality as eICT’s and Healthy Family transmittals.

  9. MAGI Referral Search Each of these options represent a type of batch that was initiated.

  10. Referral Types • Referral – this is an unsolicited communication from CalHEERS. They have prescreened a customer and have found that one or more of the household members have MAGI eligibility. • Determination Change – this is an unsolicited communication from CalHEERS alerting us that a case in common has a change that requires a new MAGI determination. • Determination Response – this is a determination response from CalHEERS in which we initiated the response. This happens after we run MAGI Determination in our system. • Information Change – This is an unsolicited communication from CalHEERS alerting us that there is a change that was reported that does not require a new MAGI determination.

  11. MAGI Referral Search The date and time stamp will take you to the MAGI Referral page. The C-IV case number will take you to the case summary.

  12. New Screens and Their Functionality Let’s start from the very beginning.

  13. Case Summary

  14. Administrative Roles A new admin role has been added for CEC. This information will be sent over from CalHEERS as an authorized representative.

  15. Administrative Roles This is the information that is requested to be entered once a Certified. Enrollment Counselor option as been selected as the admin role.

  16. Certified Enrollment Counselor (CEC) • This is not the same as an authorized representative when comparing the two roles with ATPC/CSR and MC programs. • With ATPC/CSR, the CEC or any authorized representative has all the same rights as the customer themselves. • MC does not allow these same rights UNLESS the customer has provided written permission using the MC 306 (Appointment of Representative) that must be updated annually.

  17. Non-Financial

  18. Individual Demographics New fields will now auto populate if a customer does not have a social.

  19. Individual Demographics • If the ATIN/ITINis selected, another field will populate and will become a required field. This is where the ATIN/ITIN will need to be entered. • “An ATIN is an Adoption Taxpayer Identification Number issued by the Internal Revenue Service as a temporary taxpayer identification number for the child in a domestic adoption where the adopting taxpayers do not have and/or are unable to obtain the child's Social Security Number (SSN). The ATIN is to be used by the adopting taxpayers on their Federal Income Tax return to identify the child while final domestic adoption is pending.” www.irs.gov • “An Individual Taxpayer Identification Number (ITIN) is a tax processing number issued by the Internal Revenue Service. It is a nine-digit number that always begins with the number 9 and has a range of 70-88 in the fourth and fifth digit. Effective April 12, 2011, the range was extended to include 900-70-0000 through 999-88-9999, 900-90-0000 through 999-92-9999 and 900-94-0000 through 999-99-9999. IRS issues ITINs to individuals who are required to have a U.S. taxpayer identification number but who do not have, and are not eligible to obtain a Social Security Number (SSN) from the Social Security Administration (SSA).ITINs are issued regardless of immigration status because both resident and nonresident aliens may have a U.S. filing or reporting requirement under the Internal Revenue Code.Individuals must have a filing requirement and file a valid federal income tax return to receive an ITIN, unless they meet an exception.” www.irs.gov

  20. Customer Options New options that will need to be used when completing a MAGI determination.

  21. Customer Options • There are three new options that have been added to this screen. • The Verification Consent and Maintain Verifications need to be added for the primary tax filer only. • Remember, customer has to consent to verifications (The Hub) in order for their application in CalHEERS to continue. • Full Medi-Cal Hierarchy will only be filled out IF the customer has opted for this. This means the customer wants to be screened for traditional MC (now known as non-MAGI). If the customer has not declared, then the assumed answer is no. • This will need to be entered for each person for which they are requesting non-MAGI screening.

  22. Financial

  23. Tax Household List This has been added to the Financial Section. This is a mandatory field to run MAGI. This determines the tax filing household status.

  24. Tax Household List These are the only two options for dependent types. Non-Custodial Parent is used when the child is not in the home but claimed on taxes. This is an example of the primary tax filer Tax Household Detail screen.

  25. Tax Household List Another screen will need to be added when a case has two adults. Remember, a spouse is not a dependent. The dependents will need to be added to the primary tax filers’ screen.

  26. Determining Eligibility

  27. Running EDBC Error Message MAGI Determination MUST be done before running the case.

  28. Running EDBC • Before a case can be ran, MAGI determination MUST be done first. Running MAGI determination will not automatically load into C-IV. • You will also notice that the message indicates that the results must be marked as reviewed. This just means you need to review the results of the MAGI Determination after a response has been received from CalHEERS before you can proceed. This process will be explained in more detail later in presentation. • After the MAGI results have been determined, then you MUST run the case with EDBC to upload the MAGI or non-MAGI aid code into C-IV. • If the customer has opted for Full MC Hierarchy, then this is where you can show which choice the customer has made. • The functionality of this will be shown later in this presentation.

  29. Navigating to MAGI Eligibility • MAGI Eligibility is located in Customer Information. This task will be near the Run EDBC task. • Before MAGI Eligibility can be run, you MUST have the tax filer information completed. • It will also be mandatory to have the customer options for the primary tax filer completed. • As with EDBC, the relationship grid will need to be completed. • The Vital Statistic screen will not be mandatory for MAGI Determination but you will need to have this screen completed before running EDBC.

  30. Reminder Time!!!! • As with every Re-Evaluation, Application, e-Transaction, etc., you should be checking EVERY task in both non-financial and the financial sections of the case. • Even if this case is a new to C-IV case, there could be some information that transferred over from the e-Source that may not show in the root questions. • For Example: There are not any root questions regarding primary tax filer or tax filing status. Check all screens to make it clean

  31. Running MAGI Determination See next slide for more information regarding this screen.

  32. Running MAGI Determination • The Benefit Month will default to the future month. • This will also show the history of all the benefit months that have been previously ran. • To complete a negative action (such as customer withdrawal), you will select the box labeled “Request Negative Action Determination.” • The resulting changes to the page will reflect current functionality on the negative actions task from the Case Summary. • The Life Change Event will determine if the customer is eligible to a special enrollment period and this information will be located within the MAGI Referral page.

  33. Running MAGI Determination Changes to screen when the Request Negative Action Determination is selected.

  34. Running MAGI Determination Choices for negative actions for MAGI.

  35. Running MAGI Determination Choices for life change events also known as special enrollment period reasons.

  36. Running MAGI Determination This message is received once you have selected the request MAGI button. This page runs in real time similar to EDBC. Clicking the view button will refresh the page so that the results will post and the message center will appear.

  37. Message Center The Message Center appears once the MAGI determination results have been completed.

  38. Message Center Double click the globe icon to open the message center. There are two hyperlinks in the message. The first indicates the time the message was received and will direct you to the MAGI Referral Detail Page. The second is the case number and will direct you to the case summary.

  39. Message Center • The message center is both case sensitive and worker sensitive. • Ideally, these will come back within seconds upon requesting MAGI determination. • In the event that there is a lag in response, the message center will show for one day upon the receipt of the determination. It will also show on any page you are currently working, in or out of the case. • The message will automatically drop at the end of the day. • The message will show in the workload inventory after it is dropped in the message center. • Remember that EDBC cannot be run until after the MAGI determination response (DER) has been received from CalHEERS.

  40. Message Center The CalHEERS icon will show when a case has a MAGI determination that needs to be reviewed and completed.

  41. MAGI Determination Results Once a message has been received, the results for the month that was ran will show under the Search Results Summary.

  42. MAGI Determination Results This page is accessed from the hyperlink of the benefit month. This shows who is eligible and their aid code. The hyperlink of each person will take you to the individual demographis associated with the MAGI Referral Page. (Shown later)

  43. MAGI Referral Detail There are two ways to get to this page. One is from the hyperlink from the message center. The other is through the referral search shown previously.

  44. MAGI Referral Continued Bottom portion of the MAGI Referral Page. You will also notice that the results from CalHEERS are also presentif the case was a referral from CalHEERS.

  45. MAGI Referral • This page functionally works very similar to the eICT and IAT detail screen. • There will be hyperlinks for each member of the case. • These hyperlinks will take you to their individual demographics (including income) along with The Hub results. These will be on the bottom of the page and will be listed as E Verifications. • There will also be indicators if the customer has physically verified any information. • There is a referral section. If the customer has requested other programs such as CalFresh, then a checkmark will appear before the program. • This page is both updated/created both by C-IV and CalHEERS.

  46. MAGI Person Detail To maneuver to this screen, you click the hyperlink for the person from the MAGI Referral page or from the MAGI Determination Results.

  47. Bottom of MAGI Person Detail The biggest change in this screen than from other e data screens is the Verification section. Admin-Verified is items that have been sight verified. E-Verified are items that have been verified via “The Hub.”

  48. e-Data from CalHEERS You’ll notice that the arrows are the same as an e-App.

  49. e-Data from CalHEERS The accept all button usually located on the top of the screen is not there. You will notice that some fields are pre-filled with data. Clicking on the arrow (or CalHEERS icon) will bring up the e-Data.

  50. e-Data From CalHEERS By clicking on the information brought up, this will fill in the field for which it is intended.