Eligibility Data and Image Transfer System EDITS

1. Eligibility Data and Image Transfer SystemEDITS November 6, 2008

2. Contacts Sam Morcos Assistant Deputy Commissioner Information Technology & Client Services NYC Human Resources Administration Medical Insurance & Community Services Administration Tel. (212) 273-0022 Email morcoss@hra.nyc.gov Catherine Ray Director Administrative and Operational Technology Solutions NYC Human Resources Administration Management Information Systems Tel. (718) 510-0429 Email rayc@hra.nyc.gov

3. 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. Introduction

4. 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 What is EDITS? EDITS is a front-end system to WMS for Public Health Insurance that:

5. 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. Very Important Facts

6. Medicaid Caseload PRWORA 1996 HCRA 2000 DRM 2001 FHP 2002

7. FTP SERVER IN DMZ Firewall EDITS FTP MAPEDITS 1 EDITSAPP 330 W 34 A TH ( 34 STREET - TH ( 34 STREET ) Production DB ) SUNIMG ( Filenet EDITSWEB 330 W 34 A Production ) TH ( 34 STREET ) WMS PRODUCTION DB Elig. WORKER Elig. WORKER Elig. WORKER System Overview SUBMITTERS

8. 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 EDITS behind the scene processes

9. EDITS Impact on Provider’s Process

10. EDITS Impact on MICSA’s Process

11. Productivity Increases

12. EDITS Growth

13. 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. Certification Process