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 - Richard.Evans@okhca.org

Derek Lieser , Project Manager

Planning and Development

405.522.7376 - Derek.Lieser@okhca.org