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Human Resources AdministrationDepartment of Social Services
1
Eligibility Data and Image Transfer SystemEDITS
November 6, 2008
Human Resources AdministrationDepartment of Social Services
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Sam MorcosAssistant Deputy Commissioner
Information Technology & Client ServicesNYC Human Resources Administration
Medical Insurance & Community Services Administration
Tel. (212) 273-0022Email [email protected]
Catherine Ray Director
Administrative and Operational Technology Solutions
NYC Human Resources AdministrationManagement Information Systems
Tel. (718) 510-0429Email [email protected]
Contacts
Human Resources AdministrationDepartment of Social Services
3Introduction
• Expansion of public health insurance and keeping eligible persons enrolled has been a city and state goal since welfare reform.
• Unlike other programs Public health insurance permits delegation of the application face to face interview to certified representatives or facilitated enrollers.
• Medical providers (hospitals, nursing homes, and managed care plans) as well as community based organizations, perform this role in New York City.
• Many of these entities have automated systems to collect public health insurance application data and print it on the applications that are then sent in hard copy to MICSA for review and entry to WMS.
• Since 2000, over 79% of the monthly volume of 48,827 applications is submitted by these intermediaries in this manual fashion.
Human Resources AdministrationDepartment of Social Services
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What is EDITS?
• Receives data and images transferred from the systems of certified submitters
• Commits images automatically into the HRA image repository • Provides the HRA eligibility worker access to the Applicant’s
data and the supporting documentation on the desktop• Automates application registration into WMS and prepares
application records for review and eligibility determination by HRA-MICSA staff
• Presents initially submitted budget data for worker review, adjustment and approval
• Transfers data and decisions to WMS• Provides submitters electronic data containing application
decisions
EDITS is a front-end system to WMS for Public Health Insurance that:
Human Resources AdministrationDepartment of Social Services
5Very Important Facts
• EDITS is a NYC owned system.• EDITS is not mandatory.• Upon delivery of completed EDITS application, NYC HRA MIS will
have full responsibility for maintenance and future enhancements.• Only authorized HRA employees have direct access to EDITS.• Submitters cannot see or access EDITS directly. They can only
submit data and image files for EDITS’ use.• To join EDITS, submitters must have their own system to collect
data and images.• Submitters have the choice of using their own IT departments or
contracted services to develop a system capable of creating files according to EDITS specifications.
• Submitters are responsible for developing and maintaining their own systems (which include hardware and software) to remain in compliance with any changes resulting from State WMS enhancements/changes that affect EDITS.
Human Resources AdministrationDepartment of Social Services
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Medicaid Caseload and Staffing
300,000
600,000
900,000
1,200,000
1,500,000
1,800,000
2,100,000
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MA
On
ly C
ases
MA-Only Population
Medicaid Caseload
PRWORA
1996
HCRA
2000
DRM
2001
FHP
2002
Human Resources AdministrationDepartment of Social Services
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FTP SERVER IN DMZ
SUBMITTERS
EDITS FTP
EDITSAPP330W34A
(34TH
STREET )
EDITSWEB330W34A
(34TH STREET)
MAPEDITS 1 (34
TH STREET -
Production DB )
SUNIMG(Filenet
Production)
WMS PRODUCTION DB
Elig. WORKERElig. WORKERElig. WORKER
Firewall
System Overview
Human Resources AdministrationDepartment of Social Services
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EDITS behind the scene processes
• EDITS ensures compliance with Medicaid policies by:–Validating data and images files transmitted by submitters–Performing completeness and accuracy test for each
application record–Rejecting incomplete/inaccurate application records and
notifying submitter of rejection and reason(s)–Monitoring timeliness of submission and process of
applications
• Application Registration into NYS WMS system and obtain registration number
• Prepare application records for supervisory assignment
Human Resources AdministrationDepartment of Social Services
9EDITS Impact on Provider’s ProcessBEFORE AFTER
1. Pre-Screen potential applicants 1. Pre-Screen potential applicants
2. Conduct interview 2. Conduct interview
3. Collect completed applications 3. Collect completed applications
4. Collect required documentation 4. Collect required documentation
5. Copy required documentation for each application
6. Data enter application data into their own information system 5. Data enter application data into their own information system
7. Image documentation into their own information system 6. Image documentation into their own information system
8. Prepare a transmittal for applications that are ready for submission to MICSA
9. Send applications and documentation via a messenger to MICSA
10. Obtain a signed receipt from MICSA for submitted applications
11. Follow up calls to HRA inquiring about application status
12. Collect Turn-around Document (TAD)
7. Transmit electronic Data and Image files to EDITS
Human Resources AdministrationDepartment of Social Services
10EDITS Impact on MICSA’s ProcessBEFORE AFTER
1. Receive paper batches of applications
2. Maintain manual files in date order to ensure timely processing
3. Audit application records and documents to ensure appropriate and complete submissions
4. Return incomplete/inappropriate records to submitter
5. Register application into State Welfare Management System (WMS)
6. Wait for Resource File Integration (RFI) 3-5 days 1. Wait for Resource File Integration (RFI) 3-5 days
7. Data enter application information and financial data into State Welfare Management System (WMS)
8. Review consumer data and supporting documentation 2. Review consumer data and supporting documentation
9. Provide a decision 3. Provide a decision
10.Supervisor review, approval, and transmission to WMS 4.Supervisor review, approval, and transmission to WMS
11. Create decision notification to applicant and submitter
12. Prepare case records for imaging
13. Collection of Case records by imaging agent
14. Imaging of records by agent
15. Submission of images to HRA MIS
16. Storage of images into HRA repository
17. Respond to submitter inquires on case status 5. Respond to submitter inquires on case status
18. Respond to error correction requests from submitters
Human Resources AdministrationDepartment of Social Services
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Productivity Increases
Manually EDITS
Applications Per Worker Per Day
12 Applications 15 Applications
Time to complete eligibility decision
25 Days 15 Days
Human Resources AdministrationDepartment of Social Services
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EDITS Growth
2005
Initial Implementation
2008
YTD 9/30/08
Certified Submitters
1 3
Approved Providers
49 88
Human Resources AdministrationDepartment of Social Services
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Certification Process
• The Submitter must successfully pass the Certification Process on the test environment in order to proceed with EDITS.
• The process is detailed in the Submitters Specifications Document posted on the EDITS web site.
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