Detail System Design - DED



Updated Processes

This section documents any further clarifications made to the details of specific business processes since the General System Design (GSD). The details of business processes that have not changed since the GSD phase will continue to reside in the GSD document.

1 CCMS-BP-ELI-001 Process an Application

This process defines the steps for when a client applies for the Child Care Assistance Program (CCAP). This business process documents the steps needed from the time an application form is received until the client’s program eligibility is determined. The system will generate alerts to the eligibility workers after a certain amount of time to inform them that follow-up actions are needed on the case and to deny it if the client has not returned the required information.

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Figure 3-1. Process an Application

2 CCMS-BP-ELI-002 Process a Redetermination

This process defines the steps needed to complete a redetermination of eligibility for the CCAP. Two months before the end of a client’s eligibility period, a redetermination form is sent out for the client to complete. Once the completed form is received, an eligibility worker may request the client to submit additional information to process the case. This could include paystubs, grades, or other supporting documentation. Once all the required information has been received and validated, eligibility is determined and the client’s child care services are either approved for a new eligibility period or the services are cancelled.

[pic]Figure 3-2. Process a Redetermination

3 CCMS-BP-ELI-003 Process a Change of Information

This business process documents the steps needed to change a client’s information without affecting the client’s eligibility dates. Some examples of the information that may change include name changes, change of address, and the birth of a child. Once it is determined that there is a change of information, an eligibility worker may request supporting documentation to substantiate the change. Once the required information is available, eligibility is determined and the change may be approved or the case may be cancelled if the change results in discontinued eligibility.

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Figure 3-3. Process a Change of Information

4 CCMS-BP-ELI-004 Process a Shared Case

This process defines the steps for when an application, redetermination or change of information is processed, in which a shared case is created or modified. A shared case is an instance where one family’s child care assistance is managed by more than one entity. This could be two sites or a CCR&R and a site. This business process includes approval and communication steps between the sites or R&R and site. This process documents the steps needed from the time an application, rede, or COI form is received until the client’s program eligibility is determined. The system will generate alerts to the eligibility workers after a certain amount of time to inform them that actions are needed in the case and to cancel it if the client has not returned the required information.

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Figure 3-4. Process a Shared Case

5 CCMS-BP-ELI-007 Transfer a Shared Case

This process describes the steps undertaken in transferring a case from one organization to another. This process is called a transfer when a case moves from a CCR&R to a site or vice versa, or from one site to another. If the transfer occurs mid-service month, the case becomes a shared case temporarily until the next service month begins. The process requires communication between the CCR&Rs and the BCCD Shared Case Coordinator. CCMS generates alerts to notify the coordinator when action is necessary.

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Figure 3-5. Transfer a Shared Case

6 CCMS-BP-PIQA-001 Schedule a Field Review

BCCD PIQA conducts Field Reviews of CCR&Rs and Providers according to a three year cycle. Once a target is selected, the PIQA Supervisor selects a review period, selects a sample size determining the number of cases to be reviewed, and associates that review with a PIQA Monitor. CCMS generates a task for that monitor. The monitor reviews records associated with clients who were provided service during the review period.

For CCR&Rs, the Monitor can generate a list of clients who were provided service during that period. CCMS obtains this data through an interface from CCTS payment files. For Providers, the Monitor must obtain payment information from MERS files.

CCMS generates a Monitoring Checklist that identifies the documents that the Monitor should review to validate that service was provided. The necessary supporting documents are also available in CCMS for the Monitor to review. If the documents are not in CCMS, then the Monitor can request that the target produce the documents during the Field Visit by generating a monitoring packet.

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Figure 3-8. Schedule a Field Review

7 CCMS-BP-CS-001 Process a Customer Service Request

This process defines the steps for handling a customer service request that reaches BCCD staff. The BCCD staff receiving this request may include Customer Service staff, Payments staff, and Training staff. The customer service requests covered by this process are: Mail Control, Web Bits, Legislative Inquiries, Complaints, Policy Clarifications, SEIU Grievances, Payment Questions, and Training Requests. A client or provider contacts BCCD with request details and send relevant documents. The BCCD staff enters the information in a customer service request data entry form. Alternatively, CCR&R or Site staff with access to CCMS may assign a customer service request to BCCD staff. The BCCD staff analyzes the request and prepares a response. The research and response details are then entered into the data entry form. A response is then submitted to the requestor. This may be done outside of CCMS for requestors that do not have access to the system or through CCMS for CCR&Rs and Sites.

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Figure 3-9. Process a Customer Service Request

8 CCMS-BP-CS-002 Process a Provider Overpayment

This process defines the steps for handling a provider overpayment. An overpayment can take place when a provider payment is higher than the cost of the services rendered due to provider or administrative error. The process begins with a provider overpayment being identified by the CCR&R, Site or BCCD staff. The CCR&R or site then completes the overpayment referral form with the overpayment details and provides supporting documentation. BCCD then reviews the documentation and determines whether there was an overpayment and whether other agencies need to be notified. If there is an overpayment, an overpayment packet is completed and is sent to the provider. The provider may then give additional documentation to reduce or rescind the overpayment. Otherwise, the provider is referred to the Bureau of Collections to settle the overpayment.

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Figure 3-10. Process a Provider Overpayment

9 CCMS-BP-CS-003 Process a Client Overpayment

This process defines the steps for handling a client overpayment. An overpayment can take place when the State pays more for services rendered than the client is entitled to, based on their eligibility details. This may be due to client or administrative error. The process begins with a client overpayment being identified by the CCR&R, Site or BCCD staff. The CCR&R or site then completes the overpayment referral form with the overpayment details and provides supporting documentation. BCCD then reviews the documentation and determines whether there was an overpayment or whether other agencies need to be notified. If there is an overpayment, an overpayment packet is completed and is sent to the client. The client may then give additional documentation to reduce or rescind the overpayment. Otherwise, the client is referred to the Bureau of Collections to settle the overpayment.

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Figure 3-1 Process a Client Overpayment

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