ATT012_TPA_ProcessFlow_Enrollment.pdf

World Trade Center Health Program – End‐to‐End Enrollment Process N

IO

SH

Th ird

‐P ar ty A dm in is tr at or (T

PA

TP

A M ai l C en te r

Ap pl ic an t

A U T O

Generate Welcome Letters and Send to Members

Start Complete the Enrollment Application

Submit Application Online?

No

Retrieve Posted Enrollment Application

Fax or Mail Application to

Program

Yes

Assign Paper Enrollment

Application for Processing

Clarify any Handwritten Application Information

Conduct Search for Duplicate Records

Translate Any Foreign Language Applications into English prior to

Entry

Retrieve and Digitize Enrollment Application

Make Files Available to Enrollment Processors

CARE

CARE

Finalize Enrollment Decision

Assign Enrollment Application to Reviewer

Review Application for Completion and

Qualification

CARE CARE

CARE

Confirm Received Documentation is

Sufficient

CARE

Evaluate the

Application and Select Appropriate

Outcome

CARE

QA Application for Accuracy and Completion

CARE

Initiate follow up calls

Initiate follow up letters

CARE

CARE

Move Old Enrollment Record to “Complete”

Change Member Categorization

Enter Demographics and Generate New

911#

A U T O

Transmit Application to CARE Portal

Review Number of Online Enrollment

Applications

Assign Online Enrollment

Application for Processing

CARECARE

CARECARECARE

Assign Enrollment Application to Entry QA Reviewer(s)

Member Enrolled?

Perform Appropriate Follow Up Actions

No

OASIS applications require limited demographic data entry

Download New Application List

Send Applicant List to Department of Justice (DOJ)

Supporting documentation received?

Yes

No

QA activities include ensuring accurate data entry and appropriate evaluation result

End

Enter Demographic Information

A

End

Move Old Enrollment Record to “Complete”

Change Member Classification

Enter Demographics and Generate New

911#

Review Number of Paper Applications

A U T O

Generate Member 911#

A

Receive Applicant List from DOJ and

Update TSC Clearance Date

End TSC

Sufficient for Decision?

Yes

No

B

B

Yes

C

C

D

D

Submit Application for NIOSH Review and Decision

Legend

Start/End

Activity Step

Decision Step

Predefined Process/ Subprocess

Annotation

On‐page ConnectorSystem[Name]

A U T O Automated Activity

OASIS

Receive Decision Data and Create Member Record

Update Member Status to Reflect

Enrollment Decision

Assign Eligibility Benefits and

Determine CCE/NPA

Send Member Information to CARE through Demographic Data

Exchange

Send Member Information to Data Centers through New Enrollee File

Assign CCE

Application becomes Inactive after 90 days

CARE

CARECARECARE

The Reclassification Subprocess is a mechanism to change the member type (Responder or Survivor) once a member is already enrolled in the Program. This requires a change to the 911#.

CARE CARE

Applicant receives numerous calls and letters throughout 90‐day suspend process. Letters are auto‐ generated by CARE based on processor input.

CARE CARE

Applicants must be cleared by TSC in order to enroll in the Program.

The Recategorization Subprocess is a mechanism to change the member type (Responder or Survivor) of an applicant before a decision is placed on the record. This requires a change to the 911#.

CARE

Text

“Application” is used in this diagram to include both the application itself and any supporting documentation. Supporting documentation may also be submitted separately, and would follow the same process, with the additional step of having to be linked to the existing application materials.

Application content changes require OMB approval; however, design and format of the form is flexible. There are four different applications based on enrollment eligibility category—FDNY Responder; General Responder;

Pentagon/Shanksville Responder; Survivor

Although applicants often submit more than one application, all submitted materials should be consolidated into a single record to facilitate appropriate and informed decision‐making

Follow‐up actions include resolving errors preventing successful data import and generating and mailing appropriate letters.

Enrollment decisions and information are transmitted daily from CARE to the TPA

CARE generates welcome letters daily, based on the new member information from the Demographic Data Exchange received the previous day. The TPA is responsible for exporting the letters from CARE and mailing.

This is an Excel spreadsheet, currently sent weekly via a Secure File Transfer Protocol (SFTP)

CCE/NPA assignment is determined based on the member’s zip code. This determination is important as the NPA and the CCEs receive different Welcome Letters.

NYMA‐based members can select their CCE. The TPA is responsible for obtaining CCE selection information and updating the member record accordingly. A member who does not select a CCE within a certain timeframe mayl have one selected for them.

Note that the 911# is generated on application.

Therefore, it is an ID that can refer to both members and applicants. 911#s all start with “911” for responders and “911S” for survivors.

E2E Enrollment Process�