Add uniformity to HCR and CGIS authorization of benefits.

North Carolina team have recently raised a PMR WH00013155 requesting to provide straight through processing for Non-MAGI. The Merative support team have referred to SOCPM-I-964 to indicate that South Carolina had raised similar request in the past. Due to recent policy changes, the NC State is working to automate the Non-MAGI process as straight through processing to avoid manual intervention as much as possible. Also, It helps to improve the Non-MAGI application processing time and sync with MAGI processes to help workers who works both in MAGI and Non-MAGI cases.

We, North Carolina state will request reconsidering this enhancement ticket in future Curam release as it will benefit other State clients as well. Please let us know if you are looking for additional information or have any questions.

We have evaluated your request and have determined that it cannot be implemented at this time as it does not align with our current roadmap strategy and it is therefore not something that we plan to address in-product.

Your request may be resubmitted for consideration after 12 months from the date of decline.

Thank you for your interest in the Cúram product.
Sherry Byerly, Cúram SPM Offering Management team
You can find more information on the RFE process here.

After speaking with other projects, this appears to be something that should be done at the project level to affect the changes desired by SC.

In HCR you only have to authorize the case to give an eligibility determination. In CGIS you have to Check eligibility, apply changes, authorize the decision then activate the PDC to give coverage. I would much more simpler if the system just let you authorize the application and then workflow took over like in HCR.,

I spoke with Varun in Lab Services but I need more clarification on the specific steps that you feel should be automated. There may be a way to make them more uniform using workflow.

Thank you, Sherry

Thank you, Timothy. I will set up a call with IBM Lab Services to discuss this RFI along with several others and will then reach out if we need further clarification.

Thank you,
Sherry Byerly

Thanks Sherry, If the process can be configure to be a single click that would be a step in the right direction and we can work with the Si when they are on board for that. The other part that I see as very different that is not really addressed by your comment is the need of the worker to check eligibility and then approve or deny the application. Where in HCR you just click Authorize and let the system do all of the worker. If it is correct that all of that can be skipped and we can just authorize then IBM has already done the requested work and it was simply a misunderstanding on my part. Please let me know if this helps. If you would prefer a call please let me know and I can provide several times in which I am free for us to discuss any points of clarification needed.

Thank you.

Hi Timothy,

In CGISS, there are configurations available to either have a multi-step authorization process using an Intake Worker and Eligibility Worker or just a single step process using only the Eligibility Worker. Also, PD cases are automatically activated if they are Approved during the nightly batch. Can you specify which specific steps in the authorization/approval/activation process you feel are unnecessary? Keep in mind that the process must allow for multiple programs and multiple caseworker scenarios.

Thank you,
Sherry Byerly - Eligibility OM

Hi Timothy,

Thank you for your enhancement request.
We require some further analysis to determine whether or not this enhancement can be considered in a future release.
I will provide another response when our investigation is complete.

Thank you,
Sherry Byerly, Cúram SPM Offering Management team