Member & Provider Services Unit: Coordination of Benefits

# of Vpharm 201P applications processed and referrals handled monthly by COB

76Jul 2020

Line Bar
Notes on Methodology

Please note that in the above chart:

  • The solid trend line shows the total # of applications processed
  • The dotted trend line shows the total # of referrals handle 

 

Partners
  • Health Access Eligibility & Enrollment Unit (HAEEU)
  • OnBase (document processing)
  • AHS Policy Unit
  • Centers for Medicare & Medicaid Services (CMS)
  • Social Security Administration (SSA)
Story Behind the Curve

This measure will show how many 201P applications are processed on a monthly basis by the COB Unit, and whether they are completed or pended due to incomplete information. Starting in June 2019, COB expanded this measure to include the 202LTC applications that they process for VPharm and Medicare Savings Program (MSP).

Vpharm eligibility is determined by members completing either the 1) Vpharm application (201P) or 2) Medicaid application (202MED).

  • If only the 201P Vpharm application is received, the Coordination of Benefit (COB) staff process it.
  • If both the 201P Vpharm mixed household application and 202MED applications are received, HAEEU staff process them.

This measure looks at 201P Vpharm applications put into the Coordination of Benefit (COB) Unit's working que in OnBase by the Application Data Processing Center (ADPC). The COB Unit has 3 employees with access to OnBase and who have the ability to work these applications. Counts are systematically tracked in OnBase, a reporting tool and calculated monthly.

If an application is found to be incomplete (not worked) due to missing information, a notice is sent to the applicant requesting information and an extra 30 days is given to respond. Members that are given this extra time to follow up with requested information are tracked manually for measure purposes but there are system edits to either complete or close the application.

Data is unavailable for this measure for the month of January 2020 due to a staffing vacancy but will resume in February.

Due to COVID-19 emergency there is a drastic decrease in applications because Vpharm reviews have been bumped.

 

Last updated:  08/18/2020

Strategy

The PDP Team is divided into two groups. The first group handles VPharm and Medicare Savings Program eligibility and this is what has been previously measured below by the number of applications processed per month. The second group handles billing related referrals and the new field below gives an indication on the number of case referrals that group handles per month and gives a more accurate picture of the duties of the entire PDP Team.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy