TABLE OF CONTENTS



Section 9.0

Reports

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9.0 Reports 3

9.1 DPW Reports 4

9.1.1 CAO Referral Report 5

9.1.2 DPW Cross Match Reports 10

9.1.3 Contractor to CAO Referral Summary 18

9.1.4 CAO TO PID Referral Summary 20

9.2 Operational Reports 22

9.2.1 Application Entry Control Report 23

9.2.2 Letter Control Report 25

9.2.3 PCP Control Report 27

9.2.4 Non-Sync Renewal Report 28

9.2.5 Daily Operational Report 30

9.2.6 Interface File Error Report 32

9.2.7 Extended Renewal Due Date Report 34

9.2.8 To-Be-Determined Eligibility Status Report 36

9.2.9 Pending Termination for Non-Renewal Report 38

9.2.10 Monthly COMPASS Interface Report 40

9.2.11 Waitlist Reports 42

9.0 Reports

This section describes the reports that can be generated using CAPS.

The Reporting subsystem supports the operational reports that are generated based on the data within CAPS. Reports will be made available in the form of an online viewable result as well as in the form of extracted data. Data extracts will be used by the Pennsylvania Insurance Department as a basis for additional State and Federal reporting requirements.

On the Reports screen, two types of reports are listed: DPW Reports and Operational Reports.

The DPW Reports include:

• CAO Referral Report

• DPW Cross Match Reports

• Contractor to CAO Referral Summary

• CAO to PID Referral Summary

The Operational Reports include:

• Application Entry Control Report

• Letter Control Report

• PCP Control Report

• Non Sync Renewal Report

• Daily Operational Report

• Interface File Error Report

• Extended Renewal Due Date Report

• To-Be-Determined Eligibility Status Report

• Pending Termination for Non-Renewal Report

• Monthly COMPASS Interface Report

• Waitlist Reports

9.1 DPW Reports

The DPW Reports contain data that is exchanged between CAPS and the Department of Public Welfare’s Client Information System (CIS). PID will use the reports to monitor individuals that were referred to a PID CHIP/adultBasic contractor from a DPW County Assistance Office (CAO) and that were referred from PID to a CAO due to low income. In addition, the Cross Match report is used to monitor individuals that have been identified as being dually enrolled in adultBasic and a DPW Medical Assistance program.

1. CAO Referral Report

2. DPW Cross Match Reports

3. Contractor to CAO Referral Summary

4. CAO to PID Referral Summary

9.1.1 CAO Referral Report

The CAO Referral Report displays identifying information for all Application Referrals sent to the CAO from CAPS and received in CAPS from the CAO. CAPS generates an application referral to the CAO for all individuals who received either a Denied – CAO Referral or a Terminated – CAO Referral eligibility status by CAPS. These individuals’ applications are automatically sent from the contractor to the CAO. The report also displays information on automated referrals received from the CAO as a result of the CAO denying an application or terminating benefits for reasons that are appropriate for referral to the CHIP and adultBasic Program. This report is updated during the nightly batch process, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following criteria will be applied to generate this report:

• Individuals must be active

• Individuals must have an eligibility status of Denied – CAO Referral or Terminated – CAO Referral

• Individuals must be assigned to a contractor with access rights to view this individual’s data

• Authorized Users may be allowed to view this report only for counties in which their contractor provides service

The following data elements are displayed for each individual who meets the specified criteria:

• CAPS UFI: The unique form identifier number for the applicant.

• CAPS UCI: The unique client identifier number assigned to each individual on the application.

• CAPS Name: The First 10 characters of the CAPS Applicant Last Name, First name.

• CAPS Ref Status: The current referral status.

• CAPS ED Date: The date that CAPS eligibility was determined

• CAPS Status: Current CAPS eligibility status

• CAPS Rcvd/Sent Date: Displays the date the e-referral was sent to or received from the CAO

• CAPS Ref Type: Indicates whether the referral is an automated referral from the CAO, to the CAO, or Manual.

• CAPS County: The Pennsylvania County in which the applicant resides. ‘Out of State’ is also an option. (leave your mouse curser on the code number to view the county name).

• CAPS SSN: The Social Security Number on file in CAPS for the applicant.

• CAO SSN: The Social Security Number on file with the CAO

• CAO Disposition: Displays either Approved or Rejected for outbound CAPS to CAO referrals.

• CAO Disp Date: Date the disposition decision was reached by the CAO.

• CAO Fail Rsn: Displays reason why the referred individual is not eligible for MA. (leave your mouse curser on the code number to view the failed reason value). Failure reason codes are listed in the table below.

• CAO Distr: CAO district code.

• CAO Case No: The CAO Case number assigned to the referred individual.

• CAO Rcpt No: The CAO recipient number assigned to the referred individual.

• CAO App No: The CAO application number associated with this eReferral

• COMPS Ref No: The referral number assigned to this referral by COMPASS, begins with an X if it is a CAPS to CAO referral or begins with a Y if it is a CAO to PID referral.

CAO Failure Reason Codes:

|CAO Reason Code |Code Description |Reason Description |

|1 |Full Time Employment |Excess Income of this type caused the denial or termination by the CAO |

|2 |Part Time Employment |Excess Income of this type caused the denial or termination by the CAO |

|3 |Room/Board/Rent |Excess Income of this type caused the denial or termination by the CAO |

|4 |Self-Employment |Excess Income of this type caused the denial or termination by the CAO |

|9 |Net Income - Spend Down |Excess Income of this type caused the denial or termination by the CAO |

|10 |Unemployment Compensation |Excess Income of this type caused the denial or termination by the CAO |

|11 |Workers Compensation |Excess Income of this type caused the denial or termination by the CAO |

|12 |SSA Disability |Excess Income of this type caused the denial or termination by the CAO |

|13 |SSA Survivors or Retirement |Excess Income of this type caused the denial or termination by the CAO |

|15 |Veterans Disability |Excess Income of this type caused the denial or termination by the CAO |

|16 |Veterans Retirement |Excess Income of this type caused the denial or termination by the CAO |

|17 |United Mine Workers |Excess Income of this type caused the denial or termination by the CAO |

|18 |Black Lung |Excess Income of this type caused the denial or termination by the CAO |

|19 |Railroad Retirement |Excess Income of this type caused the denial or termination by the CAO |

|20 |Other pensions, IRA, KEOGH, etc. |Excess Income of this type caused the denial or termination by the CAO |

|21 |Sick Benefits |Excess Income of this type caused the denial or termination by the CAO |

|22 |Union Benefits |Excess Income of this type caused the denial or termination by the CAO |

|23 |Dividends and Interest |Excess Income of this type caused the denial or termination by the CAO |

|24 |Court Ordered Support |Excess Income of this type caused the denial or termination by the CAO |

|25 |Support from a Legally Responsible Relative living in the household |Excess Income of this type caused the denial or termination by the CAO |

|26 |Support from a Legally Responsible Relative living outside the household |Excess Income of this type caused the denial or termination by the CAO |

|27 |Lump Sum Earned Income |Excess Income of this type caused the denial or termination by the CAO |

|28 |Lump Sum Unearned Income |Excess Income of this type caused the denial or termination by the CAO |

|29 |Deemed Income of an alien sponsor |Excess Income of this type caused the denial or termination by the CAO |

|30 |Deemed Income of a Step Parent |Excess Income of this type caused the denial or termination by the CAO |

|31 |Scholarships, Loans, and Grants |Excess Income of this type caused the denial or termination by the CAO |

|32 |Voluntary Support from a Putative Father |Excess Income of this type caused the denial or termination by the CAO |

|33 |Combined Income |Excess Income of this type caused the denial or termination by the CAO |

|34 |Other Income |Excess Income of this type caused the denial or termination by the CAO |

|36 |Strikers Income |Excess Income of this type caused the denial or termination by the CAO |

|49 |Other Regulations |  |

|50 |Age |Individual does not meet age criteria for Category of Assistance |

|56 |Other Institutionalization, including imprisonment |An individual left the household due to institutionalization and as a result the remaining household |

| | |members are ineligible for MA |

|57 |Nursing Home Care Not Being Provided |A person's circumstances changed so that they no longer meet the requirements for home and community |

| | |based services. They are reviewed for other MA and determined ineligible. |

|62 |Whereabouts Unknown |An individual left the household and as a result the remaining household members are ineligible for MA |

|63 |Voluntary Withdrawal |Household requested that MA be terminated |

|64 |Permanent Move Out of State |An individual left the household and as a result the remaining household members are ineligible for MA |

|69 |GA Categorical Eligibility Requirements Not Met |Individual does not meet criteria for Category of Assistance |

|78 |Vehicles |The value of Vehicle Resources exceeds the MA Resources Limit for the household size |

|79 |Cash on Hand, Bank Accounts |The available cash resources exceed the MA Resource Limit for the household size |

|80 |Insurance, Legacies, Claims |Insurance, etc Resources are over the MA Resource Limit for the Household Size |

|81 |Real Property |Real Property Value is over the MA Resources Limit for the Household Size |

|83 |Other Excess Resources |Other Resources Value is over the MA Resources Limit for the Household Size |

|90 |Death of Payee |The death of the payee caused the remaining household members to fail eligibility |

|91 |Death of Other Household Member |The death of another household member caused the remaining household members to fail eligibility |

|93 |Other Change in Number of Persons |Removal of a person or persons from the household caused the remaining household members to MA fail |

| | |eligibility |

|602 |Profit from Self Employment |Excess Income of this type caused the denial or termination by the CAO |

|626 |EMC Excess Income |Excess Income of this type caused the denial or termination by the CAO |

|627 |EMC Failure to Maintain Employment |Individual receiving Extended Medical Coverage failed to maintain employment |

|628 |EMC No Dependent Child |Individual receiving Extended Medical Coverage no longer has a dependent child |

|654 |MNO Requirements |Individual no longer meets any of the General Assistance-related MNO categories (adults 21 - 58 who no |

| | |longer meet the 100 hour work rule.) |

|800 |GA Time Limit for Drug and Alcohol Treatment |GA eligibility due to Drug and Alcohol Treatment time limit has expired |

|802 |GA Time Limit for Domestic Violence |Time Limit has expired for Individual who qualified for GA eligibility due to Domestic Violence |

| | |Treatment |

|952 |Individuals Waiver Code is not Valid for This Category |Another Home and Community based services discontinuance code. |

|955 |Individual is not a Recipient of RSDI Benefits |Person stops receiving RSDI benefits because the SSA determines they are no longer disabled, not |

| | |eligible for any other MA |

|956 |Removed Through Exclude Mandatory/Exclude Optional Process |An individual who's income causes other family members to lose eligibility. This individual is denied |

| | |and eligibility is redetermined without them. This can be a sibling to a child but will never be a |

| | |natural parent. |

|957 |Emancipated |Individual does not meet eligibility requirements for GA related MA |

|958 |Individual is not Pregnant |Individual not pregnant and does not qualify for TANF related MA |

|959 |Not Meeting Dependent Criteria for Category of Assistance |Individual does not meet categorical requirements for TANF related MA |

|961 |Foster/Adoption Failure Reasons |An individual who stops receiving Foster Care or Addoption Assistance payments and is not eligible for |

| | |any other MA |

|962 |Not a Valid Relationship for TANF Medicaid Category |Individual does not qualify for TANF related MA |

|964 |Individual not Within 8 Months Limit of Grant Asylum or US Entry Date |Not eligible for refugee assistance since they are past 8 months since entry into the US. They were |

| | |reviewed for other MA and determined ineligible. |

|969 |MA Individual is not Employed |Individual is not eligible for GA related MA because they do not meet the employment criteria |

Report View:

9.1.2 DPW Cross Match Reports

The DPW Cross Match Reports provide information related to the results of the automated monthly cross match that is made between CAPS individuals who are currently on the adultBasic waitlist and CIS (DPW’s Client Information System) in order to identify individuals on the waitlist that are dually enrolled in adultBasic and a DPW Medical Assistance (MA) program.

Each month, all individuals who are either actively enrolled in adultBasic or are on the adultBasic waitlist are included in the DPW cross match. Waitlist individuals will not be affected by the cross match results (e.g., if they are found to be enrolled in an MA program, they will not be removed from the adultBasic waitlist). However, active adultBasic enrollees will be terminated from adultBasic with 37 days notice if they are identified as being actively enrolled in a DPW MA program.

Note: These reports only provide information for individuals on the adultBasic waitlist who were identified as being actively enrolled in a DPW MA program, not for adultBasic enrollees who were identified as being dually enrolled.

These individuals have either a Waitlist or Enrolled - Waitlist at Cost eligibility status in CAPS.

Seven DPW Cross Match Reports are currently available:

• High-level Statistics

• Total by MA Type

• MA Program Type by Contractor

• MA Program Type

• MA Termination Date

• MA Start Date

• Details of Matched Individuals on MA

9.1.2.1 High-Level Statistics

The DPW Cross Match: High-Level Statistics Report provides a count of all individuals who are currently on the adultBasic waitlist by CAPS Eligibility Status. These individuals will be sent through the automated DPW Cross Match on a monthly basis.

Report View:

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9.1.2.2 Total by MA Type

The DPW Cross Match: Total by MA Type Report displays the type of DPW Medical Assistance (MA) program in which individuals who are currently on the adultBasic waitlist are actively enrolled. These individuals will have been identified through the automated monthly DPW cross match.

Report View:

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9.1.2.3 MA Program Type by Contractor

The DPW Cross Match: MA Program Type by Contractor Report displays the type of DPW Medical Assistance (MA) program in which individuals who are currently on the adultBasic waitlist are actively enrolled; a summary is provided for each adultBasic contractor with individuals who are on the adultBasic wait list and are also actively enrolled in a DPW MA program.

Report View:

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9.1.2.4 MA Program Type

The DPW Cross Match: MA Program Type Report displays the type of DPW Medical Assistance (MA) program in which individuals who are currently on the adultBasic waitlist are actively enrolled; a count is provided for each adultBasic contractor with individuals who are on the adultBasic wait list and are also actively enrolled in a DPW MA program based on their CAPS Eligibility Status and MA program category.

Report View:

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9.1.2.5 MA Termination Date

The DPW Cross Match: MA Termination Date Report displays the MA Termination Date (if one exists) for individuals on the adultBasic waitlist that were identified as being actively enrolled in a DPW MA program. The Termination Date is the date on which an individual’s MA enrollment ended or will end.

Report View:

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9.1.2.6 MA Start Date

The DPW Cross Match: MA Start Date Report displays the MA Start Date for individuals on the adultBasic waitlist that were identified as being actively enrolled in a DPW MA program. The Start Date is the date on which an individual’s MA enrollment began or will begin.

Report View:

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9.1.2.7 Details of Matched Individuals on MA

The DPW Cross Match: Details of Matched Individuals on MA Report displays the following data items for individuals on the adultBasic waitlist that were identified as being actively enrolled in a DPW MA program:

1. adultBasic Contractor with whom the individual is on the waitlist or waitlist at cost with

2. UFI (Unique Form Identifier) for the CAPS system

3. UCI (Unique Client Identifier) for the CAPS system

4. Eligibility Status for the CAPS system

5. Completion Date for adultBasic enrollment eligibility

6. MA Type in which the individual is actively enrolled with DPW

7. MA Start Date The date on which the individual’s MA coverage with DPW began or will begin

8. MA End Date The date on which the individual’s MA coverage with DPW ended or will end

Report View:

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9.1.3 Contractor to CAO Referral Summary

The Contractor to CAO Referral Report provides counts of CHIP and adultBasic applications that were either denied for low income or terminated for low income and subsequently referred to a CAO during a particular month.

The following criteria will be applied to generate this report:

• Individuals must have been assigned an eligibility status of Denied – CAO Referral or Terminated – CAO Referral during the particular month

• Individuals must be assigned to a contractor with access rights to view this individual’s data

The following data elements are displayed in the report:

|Field |Description |

|Total Number of Referral Applications |The total number of applications that were either terminated or denied due to low income and were |

| |subsequently referred to a DPW County Assistance Office. |

|Total Number of Referral Individuals |The total number of applicants that were either terminated or denied due to low income and were |

| |subsequently referred to a DPW Count Assistance Office. |

|Average Turnaround Time Per Individual |The average length of time in days between the CAPS eligibility determination date and the date the |

| |application status was determined in CIS (the DPW Client Information System) for an individual. |

|Number of Individuals Outside Turnaround Time |The number of unique individuals whose turn around time was longer than the average turn around time. |

|Individuals Terminated in CAPS |The number of unique individuals who were assigned a Terminated-CAO referral status in CAPS during the |

| |selected month. |

|Individuals Denied in CAPS |The number of unique individuals who were assigned a Denied-CAO Referral status in CAPS during the |

| |selected month. |

|Individuals Rejected in CIS |The unique number of individuals rejected in COS who were referred to CIS during the selected month. |

|Individuals Approved in CIS |The unique number of individuals approved to receive MA who were referred to CIS during the selected |

| |month. |

|Individuals Pending in CIS |The unique number of individuals who were referred to CIS during the selected month who have not been |

| |rejected or approved by CIS. |

Report View:

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9.1.4 CAO TO PID Referral Summary

The CAO to PID Referral Report provides counts of CHIP and adultBasic applications that were referred to PID by a DPW CAO during a particular month after the individual was denied DPW Medical Assistance (MA) coverage.

The following data elements are displayed in the report:

|Field |Description |

|Total Number of Referrall Applications Suspended |The total number of referred applications from the CAO that are currently suspended in CAPS |

|Total Number of Referral Applications Processed |The total number of referral applications that were processed in CAPS |

|Total Number of Individuals Suspended |The total number of referred individuals who are suspended in CAPS |

|Total Number of Individuals Processed |The total number of referred individuals who have been processed in CAPS |

|Total Number of Referral Applications Deleted |The total number of referral applications deleted from the suspended applications page in CAPS. |

|Average Turnaround Time Per Individual |The average length of time in days between day the referred individual is suspended in CAPS and the day |

| |when the individual is processed in CAPS. |

|Number of Individuals Outside Turnaround Time |The number of unique individuals whose turn around time was longer than the 15 day allowable processing |

| |time |

|Individuals Enrolled |The number of unique individuals who were referred to a CHIP/aB contactor and were subsequently enrolled |

| |in CAPS. |

|Individuals Denied |The number of unique individuals who were referred to a CHIP/aB contractor and were subsequently denied in|

| |CAPS. |

|Individuals Pending |The unique number of individuals who are in a pending status. |

Report View:

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9.2 Operational Reports

Operational reports will be used by PID and the CHIP/adultBasic contractors for benchmarking and quality assurance.

1. Application Entry Control Report

2. Letter Control Report

3. PCP Control Report

4. Non Sync Renewal Report

5. Daily Operational Report

6. Interface File Error Report

7. Extended Renewal Due Date Report

8. To-Be-Determined Eligibility Status Report

9. Pending Termination for Non-Renewal Report

10. Monthly COMPASS Interface Report

11. Waitlist Reports

9.2.1 Application Entry Control Report

The Application Entry Control Report displays the number of applications that have been received or entered into CAPS during a specific timeframe. This report is updated online once per day, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following criteria will be applied to generate this report:

• Individuals must be active

• Individuals must be assigned to a contractor with access rights to view this individual’s data

The following data elements will be displayed for each individual who meets the specified criteria:

• UFI (Unique Form Identifier)

• Head of Household First Name

• Head of Household Last Name

• Head of Household SSN

• Received Date

• CAPS Entry Date

• Entered By (user who entered the application into CAPS)

• Updated By (the user who last updated the application in CAPS)

Report View:

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9.2.2 Letter Control Report

The Letter Control Report displays the total number of 834 and LGF (letter generation) interface files that were transmitted from CAPS to the CHIP and adultBasic contractors on a particular day. This report is updated online once per day, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following data elements will be displayed for each individual who meets the specified criteria:

• Processed – files that were successfully generated and submitted to the contractor

o Letter Type

o Count

• Error – files that were not generated and submitted successfully to the contractor

o Letter Type

o Count

Report View:

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9.2.3 PCP Control Report

The PCP Control Report displays the number of PCPs (Primary Care Physicians) that are assigned to each contractor. This report is updated online once a day, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following data elements will be displayed for each individual who meets the specified criteria:

• Contractor Name

• PCP Count

Report View:

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9.2.4 Non-Sync Renewal Report

The Non-Sync Renewal Report displays applications with individuals that have different renewal due dates. This report is updated online once per day, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following criteria will be applied to generate this report:

• Individuals must be active

• Individuals must be assigned to a contractor with access rights to view this individual’s data

• Applications must have one person with a different Renewal Due Date than the other individuals on the application, when the individuals are all enrolled with the same contractor

The following data elements will be displayed for each individual who meets the specified criteria:

• UFI (Unique Form Identifier)

• Head Of Household

• UCI (Unique Client Identifier)

• First Name

• Last Name

• Program

• Sub Program

• Eligibility Status

• Renewal Due Date

Report View:

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9.2.5 Daily Operational Report

The Daily Operational Report displays the details of batch activities for a specified day. This report is updated online once per day, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following data elements will be displayed for a specific day:

• Statuses of the batch jobs run

• Statuses of the Inbound files to CAPS

• Compass statistics related to the number of applications and renewals received

• Statuses of the Outbound files from CAPS

• Help Desk statistics for the day

• Data Fix statistics for the day

Report View:

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9.2.6 Interface File Error Report

The Interface File Error Report shows any errors that were detected on the inbound file received from each contractor on a given day. This report is updated online once per day, and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following data elements will be displayed for each inbound record that was received in error:

• UFI (Unique Form Identifier)

• UCI (Unique Client Identifier)

• File (834, LGF, IDF, etc.)

• Contractor

• Error Code

• Error Description

• Updated Date

• Updated By

Report View:

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9.2.7 Extended Renewal Due Date Report

The Extended Renewal Due Date Report is a report that shows all individuals within a specific contractor with an eligibility period of more than 12 months. This report is updated online once per day and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following criteria will be applied to generate this report:

• Individuals must be active

• Individuals must be assigned to a contractor with access rights to view this individual’s data

The following data elements will be displayed for each individual who meets the specified criteria:

• UFI (Unique Form Identifier)

• UCI (Unique Client Identifier)

• Eligibility Determination Month

• Renewal Due Date

• Eligibility Run Date

Report View:

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9.2.8 To-Be-Determined Eligibility Status Report

The To-Be-Determined Eligibility Status Report provides a list of individuals who are applying for CHIP or adultBasic coverage (the “Applying?” question is set to “Yes”), who also have a To Be Determined status (e.g., have not yet been assigned an eligibility status). Each record should be reviewed to determine whether the individual is awaiting an eligibility determination, in which case eligibility should be determined online, or if the “Applying” question should simply be changed to “No.”

The following criteria will be applied to generate this report:

• Individuals must be active and applying for CHIP or adultBasic coverage

• Individuals must currently have no assigned eligibility status in CAPS (will read “To Be Determined” on the eligibility screen

• Individuals must be assigned to a contractor with access rights to view this individual’s data

The following data elements will be displayed for each individual who meets the specified criteria:

• UFI (Unique Form Identifier)

• UCI (Unique Client Identifier)

• Updated By

• Updated Date

• Received Date

• Entry Date

Report View:

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9.2.9 Pending Termination for Non-Renewal Report

The Pending Termination for Non-Renewal Report enables a user to retrieve a list of CHIP and adultBasic enrollees who have a renewal due within the next 97 days but have not yet renewed their CHIP or adultBasic coverage. The head of household name and phone number are included in the report so that they can be contacted for a renewal reminder, as necessary.

The user will be able to specify the list of enrollees to be returned in the report based on their Renewal Due Date. This report is updated online once per day and may be generated on an as-needed basis by an authorized CAPS user. The Reports screen can be accessed by selecting the Reports tab.

The following criteria will be applied to generate this report:

• Individuals must be active

• Individuals must be assigned to a contractor with access rights to view this individual’s data

• Individuals must have received a 30/60/90-day renewal notice (e.g., must have a renewal due within 97 days)

The following data elements will be displayed for each individual who meets the specified criteria:

• UFI (Unique Form Identifier)

• UCI (Unique Client Identifier)

• Home Phone

• First Name

• Last Name

• Head of Household First Name

• Head of Household Last Name

• Program

• Sub Program

• Enrollment Begin Date

• Enrollment End Date

• Renewal Due Date

Report View:

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9.2.10 Monthly COMPASS Interface Report

The Monthly COMPASS Interface Report provides a count of all COMPASS applications and renewals that were received for a contractor during a particular time period that is specified by the user. The count is provided per day.

The following data elements are displayed on the report:

• Contractor

• Entry Date

• Application Count

• Renewal Count

Report View:

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9.2.11 Waitlist Reports

The Waitlist Reports provide data related to the number of individuals who are currently on the adultBasic waitlist or have been “popped-off” the waitlist and were given an offer of adultBasic coverage. Only PID will have access to these reports.

Eleven Waitlist Reports are currently available:

• Wait List – Popped Off

• Wait List – Letter Info

• Wait List – Terminated Reason

• Wait List – Header

• Wait List – Individual by County

• Wait List – Grand Total

• Wait List – Inbound: CBC

• Wait List – Inbound: Highmark

• Wait List – Inbound: IBC

• Wait List – Inbound: NEPA

• Wait List – Inbound:THRV

9.2.11.1 Wait List – Popped Off

The Wait List – Popped Off Report provides the CAPS Enrollment Status by contractor for individuals who were made an adultBasic coverage offer during the most recent waitlist “pop-off” and who subsequently responded to the adultBasic offer.

The following data elements are displayed on the report:

• Contractor

• Enrollment Status

• Enrollment Count

• Total – the total number of new adultBasic enrollments attributed to the most recent wait list pop-off offer

Report View:

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9.2.11.2 Wait List – Letter Info

The Wait List – Letter Info Report provides the count of letters that were sent to individuals who were made adultBasic coverage offers during the most recent waitlist “pop-off” for each contractor and the count of responses that were received for each contractor.

The following data elements are displayed on the report:

• Contractor

• Letter Send Count – the number of letters sent to make an adultBasic coverage offer

• Respond Count – the total number of responses received from individuals who were made an adultBasic coverage offer

• At Cost Count – the total number of responses received from individuals who were in the adultBasic At-Cost program who responded to the adultBasic coverage offer

Report View:

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9.2.11.3 Wait List – Terminated Reason

The Wait List – Termination Reason Report provides information related to individuals who were made adultBasic coverage offers during the most recently waitlist “pop-off” who:

– Were Denied for no response

– Responded to the adultBasic offer and were subsequently Denied or Terminated

A count of individuals by contractor for each applicable Denial/Termination reason is provided. Please note that each individual can have more than one termination or denial reason.

The following data elements are displayed on the report:

• Contractor

• Termination/Denial Reason Code

• Contractor Count

Report View:

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9.2.11.4 Wait List – Header

The Wait List – Header Report provides information related to the total monthly cost for individuals who are currently enrolled in adultBasic and the additional monthly cost that will be required to cover individuals who have an outstanding adultBasic offer (e.g., were made an adultBasic coverage offer during the most recent waitlist “pop-off.”

The following data elements are displayed on the report:

• Contractor – Name of adultBasic contractor

• Contractor Premium – Blended adultBasic premium for each contractor

• Total Enrolled – Number of individuals currently enrolled in adultBasic

• Total Premium Req

• Total Pending Active – Number of individuals who were offered adultBasic coverage during the most recent waitlist pop-off and who have not yet responed to the offer.

• Total Amount Enrolled – Total monthly adultBasic cost for current enrollees

• Total Amount Premium Req

• Total Amount Pending Active – Additional total monthly cost required for all individuals who were offered adultBasic coverage during the most recent waitlist pop-off but have not yet responed to the offer

Report View:

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9.2.11.5 Wait List – Individual by County

The Wait List – Individual by County Report provides a count of individuals currently on the adultBasic wait list by county and contractor.

The following data elements are displayed on the report:

• County Name

• Contractor Name (Highmark, IBC, NEPA, or Unison)

• Total – Count of individuals on the adultBasic waitlist

• County Code

Report View:

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9.2.11.6 Wait List – Grand Total

The Wait List – Grand Total Report is used to identify the Application Completion Date that will be used as the cut-off for the next adultBasic waitlist pop-off offer based on the total monthly cost for individuals who are currently enrolled in adultBasic and the additional monthly cost that will be required to cover individuals who have an outstanding adultBasic offer.

The following data elements are displayed on the report:

• Application Completion Date – the date on which a waitlisted individual’s application was completed

• Total Number of Applications – the number of waitlisted individuals with the specified Completion Date

• Total Amount Waitlist – the additional monthly cost required to offer adultBasic coverage to all individuals who are currently on the waitlist for the specified Completion Date, based on the contractors’ blended premium cost

• Total Amount Enrolled – the total monthly cost for individuals currently enrolled in adultBasic

• Total Amount Pending Active – the. additional monthly cost required for all individuals who were offered adultBasic coverage during the most recent waitlist pop-off but have not yet responded to the offer

• Total Amount Premium Requested

• Total Amount Premium Pending – the additional monthly cost required for all individuals who were offered adultBasic coverage during the most recent waitlist pop-off but have not yet responded to the offer

• Total Amount Enrolled Waitlist – the additional monthly cost required to offer adultBasic coverage to all individuals who are currently on the waitlist for the specified Completion Date and all earlier Completion Dates

• Grand Total – the monthly amount required to cover current adultBasic enrollees, pending adultBasic enrollees (those made a coverage offer during the most recent waitlist “pop-off”), and the individuals with the specified Completion Date

Report View:

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9.2.11.7 Wait List – Inbound Reports: Unison, Highmark, IBC, and NEPA

The Wait List – Inbound Reports provide a list of each individual who was made an adultBasic coverage offer during the most recent waitlist “pop-off” and was subsequently enrolled in adultBasic by Contractor, County, and Completion Date.

Each individual will currently have an Enrolled or Enrolled – Awaiting Contractor Response (ACR) eligibility status in CAPS.

The following data elements are displayed on the report:

• Contractor

• Application Completed Date

• Unique Individual Id (the CAPS UCI Number)

• County Name

• County ID

Report View:

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