Oversight and Monitoring Unit

% of case reviews completed by HCQC during the month in which eligibility was determined correctly by HAEEU, LTC & COB

53.1%Jan 2020

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Notes on Methodology

Partners
  • Coordination of Benefits Unit (COB)
  • Health Access Eligibility & Enrollment Unit (HAEEU)
  • Long Term Care Unit (LTC)
  • DVHA Senior Management
Story Behind the Curve

This measure shows the number of cases that have been determined by Quality Control (QC) as "Correct", "Deficiency Only", "Error" or "Dropped".  The data above includes only cases in which both QC and the eligibility unit have reviewed and signed off on. These are considered “Complete” cases. They also include both "Active" and "Negative" actions.  

The trendline shows the number of cases determined "Correct" for any given sample month, meaning there were no errors or deficiencies found with the case.

Any eligibility system changes, rule changes or eligibility process changes could have influences on the number of case reviews determined "Correct".

The QC unit went live with our new database system on 2/4/2020.  Starting in October 2019 we began intense testing of the system to ensure it would be up and running by the time the January 2020 sample was pulled.  Due to the testing, it took longer to process cases.  It was also decided to put the December 2019 sample on hold indefinitely so there will not be any data for the December 2019 sample month.  We have started fresh in the SalesForce system with the January 2020 sample.  This also marks the start of the federally mandated Medicaid Eligibility Quality Control (MEQC) audit.  The reporting year for MEQC is 1/1/2020-12/31/2020.  The results of all cases reviewed in this time period will be reported to CMS by 8/1/2021.   The sample size during the MEQC audit will drop from 95 to 81 as we only need to review a minimum of 800 cases during the reporting year.  QC has oversampled to ensure the minimum requirement is met.  MEQC requires reviews from the MCA, CHIP, MABD, LTC programs. QC will continue to review VPharm programs even though these will not be reported to CMS.

 

Novembers sample size was reduced to test the universe and sample configurations for the MEQC review.

 

Last updated 08/18/2020

Strategy

The strategy will be to report these findings to the eligibility units in a timely manner so they will be able to create a corrective action as to how they will fix the case and avoid the error in the future.

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