Jamestown S Klallam Tribe Premium Sponsorship Enrollment Process Present State

Transcription

1 Walk-in presents to Jamestown Family Clinic Assister receives bill from outside provider for uninsured Tribal member or provider calls to check coverage Tribal HR Department informs CHS Coordinator/ Tribal Assister when Tribal member gains or loses coverage through Tribal employment Tribal Services (TANF, Behavioral Health, Housing) send referral for uninsured Tribal member Individual contacts CHS Coordinator/Tribal Assister Word of Mouth family member or friend mentions to CHS Coordinator/Tribal Assister another member s uninsured Database alerts CHS Coordinator/Tribal Assister of Tribal members upcoming Medicare eligibility (in 6 months) Patient calls Jamestown Clinic for - Appointment is made and will not be seen until coverage is verified and/or they have seen the Assister Appointment Scheduler documents the s electronic health record with s self-attested Scheduled presents to Jamestown Family Clinic for Does have? Patient is referred to CHS Coordinator/Tribal Assister to be screened for coverage eligibility paying premiums for employer- sponsored? Eligible for Medicare? Eligible for QHP? Assister provides to regarding selecting a plan and self-paying Assister collects required to reimburse Tribal member Assister collects relevant personal health to determine which plan/plans are best match for Tribal member the enrolled Jamestown S Klallam AND resident of Clallam or E. Jefferson? CHS Coordinator finalizes coverage s for Medicare Part B and D, or QHP eligible for WA Apple Health (WAH)? Assister gives WAH coverage printout to Assister enters sponsored member and premium in sponsorship spreadsheet CHS Coordinator/ Tribal Assister Assister pays QHP premiums monthly and issues reimbursement checks for EIS premiums and Medicare quarterly from sponsorship spreadsheet Can the provide all needed for? Patient leaves without CHS Coordinator/ Assister asks to return or call back with Jamestown S Klallam Tribe Premium Enrollment Process Present State 28

2 Jamestown S Klallam Tribe Premium Maintenance Process Present State MONTHLY PROCESS Sponsored members are asked to inform CHS Coordinator/Tribal Assister of changes in coverage or eligibility Tribal Human Resources informs CHS Coordinator/ Tribal Assister when Tribal members obtain EIS or terminate EIS Assister conducts ANNUAL REVIEW of coverage for strategic plan selection Assister maintains a spreadsheet of sponsored members and payments due Assister checks spreadsheet monthly Assister pays QHP premiums monthly and issues reimbursement checks quarterly Assister manages bank statements and reconciles monthly Assister creates monthly expenditures report Assister sends monthly expenditures report to Accounting Department 29

3 Lummi Tribe Premium Enrollment Process Present State Walk-in presents to Lummi Patient is checked in for Patient calls Lummi Medical Clinic for Appointment Scheduler asks whether they have Appointment Scheduler documents the s electronic health record with s self-attested First order of business for Coordinator each day is to check list of scheduled s to identify those who self-attested to being uninsured Coordinator calls Tribal Assister to inform him/her of scheduled s for uninsured s Scheduled presents to Lummi for Does have medical? Tribal Assister the able to provide all needed for? to the Business Office to complete an for there time to complete an before the? Tribal Assister walks from Business Office to Medical Clinic Reception Area to meet Coordinator calls Tribal Assister to the Clinic Coordinator checks in for eligible for WA Apple Health (WAH)? Does the return? to return after the or another day the CHS-Eligible? WAH eligibility screen back to the Tribal Assister gives WAH eligibility printout to Coordinator Coordinator updates s electronic health record with WAH coverage Tribal Assister provides to regarding selecting a plan and self-paying Tribal Assister partners with Tribal Assister lets the know that the Tribe will sponsor their premium - they will be contacted by the eligibility screen and handwrites ID number Tribal Assister forwards printout to selects a plan and pays the premium prints mails coverage 30

4 Lummi Tribe Premium Maintenance Process Present State MONTHLY PROCESS maintains a paper file for each sponsored client with printout of payment confirmation checks paper file and enters payment for all NEW sponsored clients in Excel spreadsheet contacts Tribal Human Resources to check if clients sponsored in the previous month were hired and obtained employer coverage pays premium for clients sponsored in the previous month if not hired by the Tribe prints for clients continued on sponsorship program forwards Requisition Form to Accounting Department attaches copies of payment confirmations for all clients sponsored this month to Requisition Form Accounting Requisition Form 31

5 Nisqually Tribe Premium Enrollment Process Initial State Walk-in presents to Nisqually Patient is checked in for Patient calls Nisqually Medical Clinic for Appointment Scheduler asks whether they have Appointment Scheduler documents the s electronic health record with s self-attested First order of business for Coordinator each day is to check list of scheduled s to identify those who self-attested to being uninsured Coordinator calls Tribal Assister to inform him/her of scheduled s for uninsured s Scheduled presents to Nisqually for Does have medical? Tribal Assister the able to provide all needed for? to the Business Office to complete an for there time to complete an before the? Tribal Assister walks from Business Office to Medical Clinic Reception Area to meet Coordinator calls Tribal Assister to the Clinic Coordinator checks in for eligible for WA Apple Health (WAH)? Does the return? to return after the or another day the CHS-Eligible? WAH eligibility screen back to the Tribal Assister gives WAH eligibility printout to Coordinator Coordinator updates s electronic health record with WAH coverage Tribal Assister provides to regarding selecting a plan and self-paying Tribal Assister partners with Tribal Assister lets the know that the Tribe will sponsor their premium - they will be contacted by the eligibility screen and handwrites ID number Tribal Assister forwards printout to selects a plan and pays the premium prints mails coverage

6 Nisqually Tribe Premium Enrollment Process Revised/Present State Walk-in presents to Nisqually Patient is checked in for Patient calls Nisqually Medical Clinic for Appointment Scheduler asks whether they have Appointment Scheduler documents the s electronic health record with s self-attested First order of business for Coordinator each day is to check list of scheduled s to identify those who self-attested to being uninsured Coordinator calls Tribal Assister to inform him/her of scheduled s for uninsured s Scheduled presents to Nisqually for Does have medical? Tribal Assister the able to provide all needed for? there time to complete an before the? Coordinator refers to Tribal Assister now stationed at Clinic Reception Area Coordinator checks in for eligible for WA Apple Health (WAH)? Does the return? to return after the or another day the CHS-Eligible? WAH eligibility screen back to the Tribal Assister gives WAH eligibility printout to Coordinator Coordinator updates s electronic health record with WAH coverage Tribal Assister provides to regarding selecting a plan and self-paying Tribal Assister partners with Tribal Assister lets the know that the Tribe will sponsor their premium - they will be contacted by the eligibility screen and handwrites ID number Tribal Assister forwards printout to selects a plan and pays the premium prints mails coverage

7 Nisqually Tribe Premium Maintenance Process Present State MONTHLY PROCESS maintains a paper file for each sponsored client with printout of payment confirmation checks paper file and enters payment for all NEW sponsored clients in Excel spreadsheet contacts Tribal Human Resources to check if clients sponsored in the previous month were hired and obtained employer coverage pays premium for clients sponsored in the previous month if not hired by the Tribe prints for clients continued on sponsorship program forwards Requisition Form to Accounting Department attaches copies of payment confirmations for all clients sponsored this month to Requisition Form Accounting Requisition Form

8 Walk-in presents to Port Gamble Medical or Dental Clinic Outside provider sends CHS Coordinator bill for uninsured Tribal member or calls to check coverage Monthly, Tribal HR Department reports names of Tribal members who gain or lose coverage through Tribal employment Clinic Biller informs when bill sent to a Tribal member s insurer is declined for coverage terminated Individual Tribal member contacts CHS Coordinator or Tribal Assister/ Word of Mouth family member or friend mentions to CHS Coordinator or Tribal Assister/ of another member s uninsured Patient calls Port Gamble S Klallam Medical or Dental Clinic for - Appointment is made provides to regarding selecting a plan and self-paying Appointment Scheduler documents the s electronic health record with s self-attested Scheduled presents to Port Gamble S Klallam Medical or Dental Clinic for the enrolled Port Gamble S Klallam AND resident of Kitsap County? further action Does scheduled Patient or other Tribal member have? eligible for WA Apple Health (WAH)? Scheduled is asked to see after to be screened for eligibility Tribal member not scheduled for is asked to come in to see to be screened for eligibility Does or other Tribal member go see? Can the provide all needed for? asks Eligible for Medicare? Eligible for QHP? collects relevant personal health to enroll in coverage finalizes coverage s for Medicare Part B and D, or QHP Assister gives WAH coverage printout to enters sponsored member and premium in sponsorship spreadsheet Does the return to meet with Tribal Assister? ship pays QHP premiums monthly and CHS Coordinator issues reimbursement checks for EIS premiums monthly and Medicare yearly Assister asks to return or call back with Port Gamble S Klallam Tribe Premium Enrollment Process Present State 34

9 Port Gamble S Klallam Tribe Premium Maintenance Process Present State MONTHLY PROCESS Sponsored members are asked to inform Tribal Assister/ of changes in coverage or eligibility Tribal Human Resources informs when Tribal members obtain EIS or terminate EIS maintains a spreadsheet of sponsored members and payments due checks spreadsheet monthly pays QHP premiums monthly submits payment printouts to CHS Coordinator CHS Coordinator sends monthly expenditures report to Accounting Department CHS Coordinator creates monthly expenditures report CHS Coordinator maintains a spreadsheet of Medicare and ESI sponsored members and payments due CHS Coordinator checks spreadsheet monthly CHS Coordinator pays ESI premium reimbursement checks monthly and Medicare Part B and D annually 35

10 Swinomish Tribe Premium Enrollment Process Present State Walk-in presents to Swinomish Patient is checked in for Patient calls Swinomish Medical Clinic for Appointment Scheduler asks whether they have Appointment Scheduler documents the s electronic health record with s self-attested First order of business for Coordinator each day is to check list of scheduled s to identify those who self-attested to being uninsured Coordinator calls Tribal Assister to inform him/her of scheduled s for uninsured s Scheduled presents to Swinomish for Does have medical? Tribal Assister the able to provide all needed for? to the Business Office to complete an for there time to complete an before the? Tribal Assister walks from Business Office to Medical Clinic Reception Area to meet Coordinator calls Tribal Assister to the Clinic Coordinator checks in for eligible for WA Apple Health (WAH)? Does go see Tribal Assister? to return after the or another day the CHS-Eligible? WAH eligibility screen back to the Tribal Assister gives WAH eligibility printout to Coordinator Coordinator updates s electronic health record with WAH coverage Tribal Assister provides Information to regarding selecting a plan and self-paying Tribal Assister lets the know that the Tribe will sponsor their premium and in the Tribal Assister Provides eligibility to purchases coverage for mails coverage 36

11 Swinomish Tribe Premium Maintenance Process Present State MONTHLY PROCESS maintains a spreadsheet to document each sponsored client and payment pays premium for clients sponsored in the previous month if there has been no notice of client acquiring other prints for clients continued on sponsorship program Monthly, forwards Requisition Form to Accounting Department attaches copies of payment confirmation for all clients sponsored this month to Requisition Form Accounting Requisition Form 37