South Carolina Department of Health and Human Services

(SCDHHS)

Member Management Replacement Program (MMRP)

Cúram Global Income Support (CGIS) Project

Architectural Description Document

(ADD)

CGIS 18 SC Department of Health and

Environmental Control (SCDHEC) Date of Death (DOD)

MMRP CGIS Program ADD

CGIS18 DHEC Date of Death (DOD) V2.0 Page 2

Version Log

The Version Log maintains a record of the changes made to the document during its life cycle.

Whole number versions are reserved to designate that the document has reached an Approved status. Changes/Revisions made to Approved documents will continue with decimals numbers, until the document again reaches an Approved status.

Version Date Drafted by Role Description of Change

0.1 01/04/2019 Tom Drennan

Business Analyst Initial draft

0.2 01/07/2019 Ken Haas MMRP Functional Lead

QA Review

0.3 01/09/2019 Tom Drennan

Business Analyst Updated document based on QA Review

0.4 01/11/2019 Tom Drennan

Business Analyst Updated document based on IBM Internal Review

0.5 02/27/2019 Tom Drennan

Business Analyst Updated document based on State review comments

0.6 02/28/2019 Tom Drennan

Business Analyst Updated document based on State review comments

0.7 03/04/2019 Tom Drennan

Business Analyst Updated document based on State review comments

0.8 03/07/2019 Tom Drennan

Business Analyst Updated process flows and narratives based on State review comments

0.9 03/08/2019 Tom Drennan

Business Analyst Added ‘Source’ field back to Interface Tab DHEC Date of Death Interfaces page based on State review comments

0.10 03/18/2019 Tom Drennan

Business Analyst Added clarification to multiple unresolved comments. Fixed typos and formatting pointed out during review.

0.11 03/28/2019 Tom Drennan

Business Analyst

Updated and resolved comments during State Q & A for Review Cycle 3. Added revised screen shot for DHEC Interface screen. Added new screen shot for DHEC Inbound Response Data screen. Added functional requirement for 5-day grace period and DHEC Interface screen.

0.12 03/29/2019 Tom Drennan

Business Analyst Resolved state comments during meeting.

0.13 04/01/2019 Tom Drennan

Business Analyst

Corrected table formatting for Review and Approval Logs sections. Removed CGIS_ from FR naming convention. Now DOD_REQ_XX.

Updated comments from 3/29/2019 Review Cycle 3 Q & A meeting.

CGIS18 DHEC Date of Death (DOD) V2.0 Page 3

Version Date Drafted by Role Description of Change

0.14 04/02/2019 Tom Drennan

Business Analyst Corrected formatting. Updated comments as a result of business meeting.

0.15 04/02/2019 Tom Drennan

Business Analyst Updated narrative flow for 15-day timer in 2.2.3.

0.16 04/04/2019 Tom Drennan

Business Analyst Updated comments to facilitate FDS approval.

Added Action Item 1140.

0.17 04/05/2019 Krishna Chennupati

Cúram Developer Added TDS Section.

0.18 5/23/2019 Tiffany Ortega

Business Analyst

Updated FDS section to align with TDS updates.

1. Added DOD_REQ_3.2.1, 4.2.1, 4.6.1, 4.11, and 4.12, 9.9, 10.1.2, 10.2.2, 10.3.4, 10.4.2, 10.5.2

2. Added the Confirmation Letter Notice link to Section 4.9

3. Updated the Output of the reports in section 4.10.1 – 4.10.5 to Crystal

Reports

0.19 1/23/2020 Tiffany Ortega

IBM BA Lead

Updated the following requirements per CR092:

Section 2.2.1 #3 Section 4.2 Section 4.2.2 #2

DOD_REQ_2.1.6.1

Section 4.2.8 #1

DOD_REQ_9.9

DOD_REQ_4.1.1

DOD_REQ_4.6.1

DOD_REQ_2.1.3

DOD_REQ_6.4

DOD_REQ_8.1

DOD_REQ_3.7

DOD_REQ_3.8

Removed the following requirements per

CR092:

DOD_REQ_4.4

DOD_REQ_5.1

DOD_REQ_6.1

DOD_REQ_7.1

DOD_REQ_6.5

DOD_REQ_7.0

DOD_REQ_7.2

DOD_REQ_7.2.1

Added the following requirements per CR092:

DOD_REQ_2.1.8

DOD_REQ_2.1.9

CGIS18 DHEC Date of Death (DOD) V2.0 Page 4

0.20 3/4/2020 Ramy Kalioby

Business Analyst

Updated following requirements per CR153:

DOD_REQ_1.2

DOD_REQ_1.2.1

DOD_REQ_1.3

DOD_REQ_1.3.1

DOD_REQ_1.4

DOD_REQ_1.4.1

DOD_REQ_1.4.3

DOD_REQ_1.4.3.1

DOD_REQ_1.4.4

DOD_REQ_1.4.5

Section 4.2 purpose Section 4.2.1 Design Description Section 4.2.2 Functional Output #1

DOD_REQ_2.0

DOD_REQ_2.1

DOD_REQ_2.1.1

DOD_REQ_2.1.2

DOD_REQ_2.1.3

DOD_REQ_2.1.4

DOD_REQ_2.1.5

DOD_REQ_2.1.5.1

DOD_REQ_2.1.6

Section 4.3 Purpose Section 4.3.1 Design Description Section 4.3.2 Functional Output #1 Section 4.3.2 Functional Output #2 Section 4.3.2 Functional Output #3

DOD_REQ_3.1

DOD_REQ_3.2

DOD_REQ_3.3

DOD_REQ_3.4

DOD_REQ_3.5

DOD_REQ_3.6

Section 4.4 purpose Section 4.4.1 Design Description Section 4.4.2 Functional Output #1 Section 4.4.2 Functional Output #2 Section 4.4.2 Functional Output #3 Section 4.4.2 Functional Output #4 Section 4.4.2 Functional Output #5 Section 4.4.2 Functional Output #6

DOD_REQ_4.0

DOD_REQ_4.1

DOD_REQ_4.1.1

DOD_REQ_4.2

DOD_REQ_4.3

DOD_REQ_4.5

DOD_REQ_4.6

DOD_REQ_4.6.1

DOD_REQ_4.7

DOD_REQ_4.8

DOD_REQ_4.9

DOD_REQ_4.10

CGIS18 DHEC Date of Death (DOD) V2.0 Page 5

Section 4.5.1 Design Description Section 4.5.2 Functional Output #1 Section 4.5.2 Functional Output #2 Section 4.5.2 Functional Output #3

DOD_REQ_5.0

Section 4.6.1 Design Description Section 4.6.2 Functional Output

DOD_REQ_6.0

DOD_REQ_6.1

DOD_REQ_6.2

DOD_REQ_6.3

DOD_REQ_6.4

DOD_REQ_6.5

Section 4.7 Purpose Section 4.7 Design Description Section 4.7.2 Functional Output #1 Section 4.7.2 Functional Output #2 Section 4.7.2 Functional Output #3

DOD_REQ_7.0

DOD_REQ_7.1

DOD_REQ_7.2

DOD_REQ_7.2.1

Section 4.8.1 Design Description Section 4.8.2 Functional Output #1 Section 4.8.2 Functional Output #2 Section 4.8.2 Functional Output #3 Section 4.8.2 Functional Output #4 Section 4.8.2 Functional Output #5

DOD_REQ_8.0

DOD_REQ_8.1

DOD_REQ_8.2

DOD_REQ_9.0

DOD_REQ_9.1

DOD_REQ_9.2

DOD_REQ_9.3

DOD_REQ_9.4

DOD_REQ_9.5

DOD_REQ_9.6

DOD_REQ_9.7

DOD_REQ_9.7.1

DOD_REQ_9.8

DOD_REQ_9.9

Section 4.10 Reports (“HH number” references updated to "Case Reference Number”)

Added following requirements per CR153

DOD_REQ_2.1.6.1.1

DOD_REQ_2.1.6.2

DOD_REQ_2.1.6.2.1

DOD_REQ_2.1.6.2.2

DOD_REQ_2.1.9

DOD_REQ_2.1.10

CGIS18 DHEC Date of Death (DOD) V2.0 Page 6

DOD_REQ_2.1.11

DOD_REQ_2.1.12

DOD_REQ_7.0.1

DOD_REQ_7.0.2

DOD_REQ_7.0.3

DOD_REQ_8.3

DOD_REQ_8.4

V0.21 04/05/2020 Vinod Mandloi

Cúram Developer

TDS Section updated for CR153

5.1.1.13

5.1.1.14

5.1.5

5.1.6

5.1.14

5.1.16.1

5.3.1

V0.22 04/09/2020 Tiffany Ortega

IBM BA Lead Updated DOD_REQ_6.0 and DOD_REQ_6.1 to align with the TDS based on TDS Review Cycle 1 of CR153.

V0.23 04/17/2020 Krishna Chennupati

Cúram Developer

Addressed Review Cycle 1 comments from Ranjan.

TDS sections updated:

5.1.1.13 5.1.5 5.1.14 5.16.1 5.3.1 5.6

V0.24 6/15/2020 Tiffany Ortega

IBM BA Lead

The following changes were made per CR212:

Updated:

DOD_REQ_1.1

Added:

DOD_REQ_1.1.3

DOD_REQ_1.1.4

DOD_REQ_1.1.5

DOD_REQ_1.1.6

DOD_REQ_1.1.7

DOD_REQ_1.1.8

V0.25 7/06/2020 Vijay Makam IBM Dev Lead Updated ESB Design sections 5.2.6.1, 5.2.6.5 per CR212

V0.26 8/3/2020 Tiffany Ortega

IBM BA Lead Updated the template, completed spelling and grammar checks for formal approval.

V1.0 9/3/2020 Erin Coleman

SCDHHS Process & Artifact Development Manager

Updated the watermark, version number and date to reflect approval. Accepted all track changes.

CGIS18 DHEC Date of Death (DOD) V2.0 Page 7

V1.1 9/21/2020 Tiffany Ortega

IBM BA Lead Updated the following per CR271:

4.10.3.1, 4.2.5.1, 4.2.5.1.1 v1.2 12/7/2020 Elena Fiske IBM Business Analyst

Updated the following for CR312:

Added report names to:

4.10.3.1, 4.10.3.2, 4.10.3.3, 4.10.3.4, 4.10.3.5

New Req added:

3.2.2, 4.6.2, 7.3, 2.1.13, 3.9, 4.13, 5.2, 6.6, 7.3 v1.3 1/15/2021 Elena Fiske IBM Business Analyst

Updates to the following for CR323:

DOD_REQ_7.4

DOD_REQ 9.2

DOD_REQ_9.9

V1.4 1/27/2021 Tiffany Ortega

IBM BA Lead Struck out section 4.10.3.3 per CR335

V1.5 1/28/2021 Kumara Balaji, Kuppan

Curam Developer Updated TDS sections for CR323 and CR335.

V1.6 1/29/2021 Tiffany Ortega

IBM BA Lead

Updated the per CR330:

2.1.1 SCDHEC Date of Death (DOD) File #6

4.1.2 Functional Output #3

4.10.3.4 SCDHEC DOD File Curam Control

Report

DOD_REQ_7.3

V1.7 2/24/2021 Dibyendu Karmakar

ESB Developer Section 5.2.3 is updated to indicate that the file format is in US ASCII.

V2.0 4/11/2021 Erin Coleman

SCDHHS Process & Artifact Development Manager

Updated the watermark, version number and date to reflect approval. Accepted all track changes.

The Review Logs maintains a record of the State personnel that performed reviews leading up to the document reaching an Approved status. These reviews do not represent final approval of the document. The Approvals are recorded in the Approval Log Section.

Functional Review Log

The Functional Review Log maintains a record of the State personnel that performed the review of the functional design, confirming the understanding of the design. That the design meets the requirements, business requirements as described and is testable.

SCDHHS Role First Review Date / Reviewer Name

Second Review Date / Reviewer Name

Third Review Date / Review Name

Business Analyst

CGIS18 DHEC Date of Death (DOD) V2.0 Page 8

SCDHHS Role First Review Date / Reviewer Name

Second Review Date / Reviewer Name

Third Review Date / Review Name

Testing Manager

Subject Matter Expert

Product Manager

Technical Lead

Technical Lead

DDI Manager

Technical Review Log

The Technical Review Log maintains a record of the State personnel that performed the review of the technical design, confirming the technical approach appropriately addresses the functional design.

SCDHHS Role First Review Date / Reviewer Name

Second Review Date / Reviewer Name

Third Review Date / Review Name

Technical Lead

CGIS18 DHEC Date of Death (DOD) V2.0 Page 9

The IBM Approval Review Logs capture the IBM Project Team personnel that reviewed the completed ADD. The Functional and Technical Design Sections have been reviewed by the IBM team. The documented design, functional and technical components are understood as documented and can be validated through the Use Cases defined. This signifies that the section/document is ready for SC personnel review and Approval.

IBM Approval Review Logs

Functional Design Section

The Functional Design Section captures the State personnel that reviewed and approved the functional design. Confirming that the design is understood, fulfills the requirements and is testable.

IBM Functional Design Approval Review – v2.0

Role Name Date Comments

CGIS Project Manager Courtney Stevens 3/23/2021 Approved v1.7 to v2.0

CGIS BA Lead Tiffany Ortega 3/23/2021 Approved v1.7 to v2.0

CGIS Testing Lead Brian Grieves 3/23/2021 Approved v1.7 to v2.0

CGIS Business Analyst Tiffany Ortega 3/23/2021 Approved v1.7 to v2.0

CGIS Development Lead Vijay Mujumdar 3/23/2021 Approved v1.7 to v2.0

CGIS Development Team Lead Randhir Singh 3/23/2021 Approved v1.7 to v2.0

Technical Design Section

The Technical Design Section captures the State personnel that reviewed and approved the technical design. Confirming that the technical approach to fulfilling design is understood fulfills the requirements.

IBM Technical Design Approval Review – v2.0

Role Name Date Comments

CGIS Development Lead Vijay Mujumdar

3/23/2021 Approved v1.7 to v2.0

CGIS Development Team Lead Randhir Singh

3/23/2021 Approved v1.7 to v2.0

Approval Logs

Functional Design Section

CGIS18 DHEC Date of Death (DOD) V2.0 Page 10

The Functional Design Section captures the State personnel that reviewed and approved the functional design. Confirming that the design is understood, fulfills the requirements and is testable.

Functional Design Approval – v2.0

SCDHHS Business Analyst Siva Mulpuri 4/7/2021 Approved V1.7

SCDHHS DDI Manager Tim Cozine 4/7/2021 Approved V1.7

SCDHHS Product Manager Abhishek Sahu 4/7/2021 Approved V1.7

SCDHHS Technical Lead Renjan Bhasi

SCDHHS Process & Artifact Development Manager

Erin Coleman 4/11/2021 Approved ADD

Technical Design Section

The Technical Design Section captures the State personnel that reviewed and approved the technical design. Confirming that the technical approach to fulfilling design is understood fulfills the requirements.

Technical Design Approval – v3.0

SCDHHS Technical Lead Renjan Bhasi

Table of Contents

1 Introduction

1.1 Background

1.2 Purpose

1.3 Scope

1.4 Key References

1.5 Definitions and Acronyms

1.6 Key Assumptions

2 Conceptual Flows

2.1 SCDHEC Date of Death (DOD) File – Processing in the ESB and Cúram

2.1.1 SCDHEC Date of Death (DOD) File – Processing in the ESB and Cúram

Narrative

2.2 SCDHEC Date of Death (DOD) File – DOD Reported Through Secondary Sources . 28

2.2.1 SCDHEC Date of Death (DOD) File – DOD Reported Through Secondary

Sources Narrative

2.2.2 Secondary Sources 30 Day Timer To Receive SCDHEC DOD Expiry

2.2.3 Secondary Sources 15-Day Timer To Receive Confirmation of Deceased

Member 32

3 Requirements Matrix

3.1 Requirement Modifications – N/A

4 Functions

4.1 SCDHEC Date of Death (DOD) File Processing in the ESB

4.1.1 Design Description

4.1.2 Functional Output

4.1.3 Design Details

4.1.4 Screen Flow Worker Portal Date of Death Interface Response Screen

4.1.5 Screen Mockups

4.1.6 Business Rules – N/A

CGIS18 DHEC Date of Death (DOD) V2.0 Page 12

4.1.7 User Roles

4.1.8 Data Fields – N/A

4.1.9 Links – Navigation – N/A

4.1.10 Links – Functions/Actions – N/A

4.1.11 Validations – N/A

4.1.12 Notifications and Tasks – N/A

4.1.13 Other – N/A

4.2 Birth and Death Details Evidence

4.2.1 Design Description

4.2.2 Functional Output

4.2.3 Design Details

4.2.4 Screen Flow

4.2.5 Screen Mockups

4.2.6 Business Rules – N/A

4.2.7 User Roles

4.2.8 Notifications and Tasks – N/A

4.3 SCDHEC DOD Person Receiving Benefits

4.3.1 Design Description

4.3.2 Functional Output

4.3.3 Design Details

4.3.4 Screen Flow – N/A

4.3.5 Screen Mockups – N/A

4.3.6 Business Rules – N/A

4.3.7 User Roles

4.3.8 Data Fields – N/A

4.3.9 Links – Navigation – N/A

CGIS18 DHEC Date of Death (DOD) V2.0 Page 13

4.3.10 Links – Functions/Actions – N/A

4.3.11 Validation – N/A

4.3.12 Notifications and Tasks – N/A

4.3.13 Other – N/A

4.4 DOD Secondary Source Person Receiving Benefits

4.4.1 Design Description

4.4.2 Functional Output

4.4.3 Design Details

4.4.4 Screen Flow – N/A

4.4.5 Screen Mockups

4.4.6 Business Rules – N/A

4.4.7 User Roles

4.4.8 Data Fields – N/A

4.4.9 Links – Navigation – N/A

4.4.10 Links – Functions/Actions – N/A

4.4.11 Validation – N/A

4.4.12 Notifications and Tasks – N/A

4.4.13 Other – N/A

4.5 Ineligible Person Open IC Another Person Receiving Benefits

4.5.1 Design Description

4.5.2 Functional Output

4.5.3 Design Details

4.5.4 Screen Flow – N/A

4.5.5 Screen Mockups – N/A

4.5.6 Business Rules – N/A

4.5.7 User Roles – N/A

CGIS18 DHEC Date of Death (DOD) V2.0 Page 14

4.5.8 Data Fields – N/A

4.5.9 Links – Navigation – N/A

4.5.10 Links – Functions/Actions – N/A

4.5.11 Validation – N/A

4.5.12 Notifications and Tasks – N/A

4.5.13 Other – N/A

4.6 External Source Open Integrated Case(s)

4.6.1 Design Description

4.6.2 Functional Output

4.6.3 Design Details

4.6.4 Screen Flow – N/A

4.6.5 Screen Mockups – N/A

4.6.6 Business Rules – N/A

4.6.7 User Roles – N/A

4.6.8 Data Fields – N/A

4.6.9 Links – Navigation – N/A

4.6.10 Links – Functions/Actions – N/A

4.6.11 Validation – N/A

4.6.12 Notifications and Tasks – N/A

4.6.13 Other – N/A

4.7 External Source Pending Case(s)

4.7.1 Design Description

4.7.2 Functional Output

4.7.3 Design Details

4.7.4 Screen Flow – N/A

4.7.5 Screen Mockups – N/A

CGIS18 DHEC Date of Death (DOD) V2.0 Page 15

4.7.6 Business Rules – N/A

4.7.7 User Roles – N/A

4.7.8 Data Fields – N/A

4.7.9 Links – Navigation – N/A

4.7.10 Links – Functions/Actions – N/A

4.7.11 Validation – N/A

4.7.12 Notifications and Tasks – N/A

4.7.13 Other – N/A

4.8 Assigning A New Primary Contact

4.8.1 Design Description

4.8.2 Functional Output

4.8.3 Design Details

4.8.4 Screen Flow – N/A

4.8.5 Screen Mockups – N/A

4.8.6 Business Rules – N/A

4.8.7 User Roles – N/A

4.8.8 Data Fields – N/A

4.8.9 Links – Navigation

4.8.10 Links – Functions/Actions – N/A

4.8.11 Validation – N/A

4.8.12 Notifications and Tasks – N/A

4.8.13 Other – N/A

4.9 Notices

4.9.1 Design Description

4.9.2 Functional Output

4.9.3 Design Details

CGIS18 DHEC Date of Death (DOD) V2.0 Page 16

4.9.4 Screen Flow – N/A

4.9.5 Screen Mockups – N/A

4.9.6 Business Rules – N/A

4.9.7 User Roles – N/A

4.9.8 Data Fields – N/A

4.9.9 Links – Navigation – N/A

4.9.10 Links – Functions/ Actions – N/A

4.9.11 Validation – N/A

4.9.12 Notifications and Tasks – N/A

4.9.13 Other – N/A

4.10 Reports

4.10.1 Design Description

4.10.2 Functional Output – N/A

4.10.3 Design Details – N/A

4.10.4 Screen Flow – N/A

4.10.5 Screen Mockups – N/A

4.10.6 Business Rules – N/A

4.10.7 User Roles – N/A

4.10.8 Data Fields – N/A

4.10.9 Links – Navigation – N/A

4.10.10 Links – Functions/Actions – N/A

4.10.11 Validation – N/A

4.10.12 Notifications and Tasks – N/A

4.10.13 Other – N/A

5 Technical Design

5.1 Common Technical Artifacts

CGIS18 DHEC Date of Death (DOD) V2.0 Page 17

5.1.1 Sequence Diagram

5.1.2 Events – N/A

5.1.3 Event Class Details – N/A

5.1.4 Domain Definitions – N/A

5.1.5 Code Tables

5.1.6 Code Table Details

5.1.7 Messages

5.1.8 Message Detailed Description

5.1.9 DMX

5.1.10 Security

5.1.11 Security Details

5.1.12 Model

5.1.13 Interfaces – N/A

5.1.14 Facades

5.1.15 Entity Layer

5.1.16 Service Layer

5.1.17 POD Definitions – N/A

5.1.18 Java Script Changes – N/A

5.1.19 CSS Changes – N/A

5.1.20 Global Configuration Changes – N/A

5.1.21 Wizard Changes – N/A

5.1.22 Menu Details – N/A

5.1.23 Evidence Configuration Changes

5.1.24 Renderers – N/A

5.1.25 Keywords (Hover Values) – N/A

5.1.26 Help Content

CGIS18 DHEC Date of Death (DOD) V2.0 Page 18

5.1.27 Links – Navigation – N/A

5.1.28 Links – Functions/ Actions – N/A

5.1.29 Validation – N/A

5.1.30 Workflow

5.1.31 Web Services -N/A

5.1.32 Java Classes

5.1.33 Task and Work queues

5.1.34 Reports

5.1.35 Unit Testing Scenarios –

5.1.36 Cúram unit Testing Scenarios

5.1.37 ESB Unit Testing Scenarios

5.1.38 Data Retention – N/A

5.1.39 Persistence Requirements – N/A

5.1.40 Backup Requirements – N/A

5.1.41 Archiving and Purging Requirements – N/A

5.1.42 Data Validation Checks – N/A

5.1.43 Security Considerations – N/A

5.1.44 Event Sequence Diagram – N/A

5.1.45 Coding Specifications – N/A

5.1.46 Table Names – N/A

5.1.47 Cúram Batch Component Technical Design - N/A

5.1.48 Batch Methods – N/A

5.1.49 Entity Classes – N/A

5.1.50 Entity Methods – N/A

5.1.51 Input/ Output Structs - N/A

5.1.52 Input/ Output Attributes – N/A

CGIS18 DHEC Date of Death (DOD) V2.0 Page 19

5.1.53 Technical Dependencies – N/A

5.1.54 Source-to-Target-Mapping – N/A

5.1.55 System Properties – N/A

5.1.56 Page Parameter Details

5.1.57 Links/Action Controls

5.1.58 Lists/Inline page Details – N/A

5.1.59 Cluster Details – N/A

5.1.60 Server Interface Details

5.1.61 UIM Configuration Changes

5.2 ESB Development

5.2.1 Outbound – N/A

5.2.2 Inbound

5.2.3 Supporting Details: Record Layout

5.2.4 ESB Operational – N/A

5.3 Rules Development

5.3.1 Rules (Rules Area)

5.3.2 Table of Values – N/A

5.4 Batch Development

5.4.1 MMDHECDOD Batch Detailed Design Overview

5.4.2 Functional Summary

5.4.3 Batch Specifications

5.4.4 Data Retention – N/A

5.4.5 Batch Classes

5.4.6 Batch Methods

5.4.7 Entity Classes

5.4.8 Table Names

CGIS18 DHEC Date of Death (DOD) V2.0 Page 20

5.4.9 System Properties

5.4.10 Code Tables

5.4.11 Code Table Details

5.4.1.1.1 MMRPTimerExpiryChunker process

5.4.1.1.2 MMRPTimerExpiryStreamer process

5.4.1.2 Functional Summary – N/A

5.4.1.3 Batch Specifications

5.4.1.4 Data Retention – N/A

5.4.1.5 Batch Classes

5.4.1.7 Input Table Names

5.4.1.8 Output Table Names

5.4.1.9 System Properties

5.4.1.10 Code Tables

5.4.1.11 Code Table Details

5.5 Non-Functional Requirements – N/A

5.5.1 Accessibility – N/A

5.5.2 Availability – N/A

5.5.3 Development Resource – N/A

5.5.4 Evolution – N/A

5.5.5 Globalization – N/A

6 Integration Points/Dependencies – N/A

7 Use Cases

7.1 SCDHEC DOD reported for a person receiving benefits in Cúram

7.2 SCDHEC DOD reported for an ineligible person present on an open IC in Cúram. 150

7.3 DOD reported by a secondary source for a person receiving benefits in Cúram. . 151

7.4 DOD is reported by a secondary source for an ineligible person present on an open

IC in Cúram

CGIS18 DHEC Date of Death (DOD) V2.0 Page 21

8 Appendixes

Appendix A: Notice of Deceased Beneficiary

Appendix B: SCDHEC DOD File Layout

Appendix C: Action Items

Appendix D: Out of Scope Requirements – N/A

Appendix E: Comments/Resolution Log – N/A

Appendix F: Approval History

CGIS18 DHEC Date of Death (DOD) V1.0 Page 22 of 163

1 Introduction

1.1 Background

The South Carolina Department of Health and Environmental Control (SCDHEC) maintains the death records for state residents. SCDHEC shares a daily file with the South Carolina

Department of Health and Human Services (SCDHHS) that contains the date of death (DOD) information for individuals. As per the current process, the file is downloaded from the FTP server manually and reports are generated on a monthly basis. Separate reports are generated for

MEDS and Cúram beneficiaries. These reports are worked manually by the eligibility workers and an automated process does not exist in the system currently.

1.2 Purpose

The purpose of this design is to define the processing of the daily inbound SCDHEC DOD file by

Cúram. The file received from SCDHEC goes through a number of steps. The SCDHEC system currently generates the inbound daily file. SCDHEC will continue to generate the inbound file.

Starting in Release 2, Cúram will process the daily inbound files. The processing of the inbound files will be covered in this document. The generation of outbound files is not in the scope of this document.

The intended audiences for this document are:

MMRP Subject Matter Experts (SMEs)

MMRP Cúram – Business Analysts

MMRP Cúram – Architecture team

MMRP Cúram – Solution Developers

MMRP Cúram – Testing Team

1.3 Scope

The purpose of this document is to detail screen flows and changes needed in Cúram to implement

SC MMRP configurations, extensions, and customizations for the SCDHEC DOD MMRP solution only. With the implementation of this project, the following areas will be addressed:

1. SCDHEC DOD File Validation and Processing

2. New DOD Interface Screen

3. Birth and Death Details Evidence Modifications

4. Household Member Evidence Modifications

5. Exception Reports

6. Estate Recovery Report

7. Control Report

CGIS18 DHEC Date of Death (DOD) V1.0 Page 23 of 163

1.4 Key References

This section lists any key documents that might be helpful to understanding the functionality which are located on the state SharePoint site.

Document Name Location

MMRP CGIS SCDHEC DOD BRD SCDHEC DOD BRD

MMRP CGIS 18 SCDHEC DOD Interface ADD RTM SCDHEC DOD RTM

MMRP CGIS 23 Global Notices ADD CGIS 23 Global Notices ADD

SCDHHS CGIS Notices Master List SCDHHS CGIS Notices Master List

1.5 Definitions and Acronyms

Term Meaning

ADD Architectural Description Document

BENDEX Beneficiary and Earnings Data Exchange

BRD Business Requirements Document

Buy-In Medicare related interface between SC and Federal agencies

CGIS Cúram Global Income Support

DOD Date of Death

ESB Enterprise Service Bus

FDS Functional Design Specification

HCR Health Care Reform

IC Integrated Case

MEDS Medicaid Eligibility Determination System

MMA Medicare Modernization Act

RTM Requirement Traceability Matrix

SCDHEC SC Department of Health and Environmental Control

SCDHHS South Carolina Department of Health and Human Services

SDX State Data Exchange System

SVES State Verification Exchange System

TDS Technical Design Specification

WF Workflow https://schhs.sharepoint.com/:w:/r/sites/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/MMRP%20CGIS18%20DHEC%20DOD%20Interface%20BRD.docx?d=wd01e88555a414c9b94f0ee47f519f824&csf=1&web=1&e=VTNhAw https://schhs.sharepoint.com/:x:/r/sites/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/MMRP%20CGIS%2018%20DHEC%20DOD%20Interface%20ADD_RTM.xlsx?d=w149ec176fb83468b927b0f192e8b0cad&csf=1&web=1&e=ZpJIf3 https://schhs.sharepoint.com/:w:/r/sites/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/MMRP%20CGIS23%20Global%20Notices%20ADD%20v1.13.docx?d=w928907f6b6d94db494c7413b04d1c3f7&csf=1&web=1&e=axO3r2 https://schhs.sharepoint.com/:x:/r/sites/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/SCDHHS%20CGIS%20Notices%20Master%20List.xlsx?d=w6cf33a678e8842a58093e7b0b8f54f8a&csf=1&web=1&e=duKEYS

CGIS18 DHEC Date of Death (DOD) V1.0 Page 24 of 163

1.6 Key Assumptions

1. The SCDHEC system will continue to generate the daily inbound Date of Death (DOD) files.

2. The current process that SCDHHS follows when a SCDHEC DOD file fails validation will not change. If an incoming SCDHEC DOD file fails ESB validations, existing SCDHEC system processes will be followed. SCDHHS staff will contact SCDHEC outside of the system, in order to get the corrected file. MMRP will provide an exception report to

SCDHHS staff to aid them in resolving the failed file.

3. The current ‘as-is’ DOD for MEDS beneficiaries process will continue to be followed.

4. The SCDHEC DOD process will be implemented in the HCR and CGIS modules of Cúram.

5. The SCDHEC DOD workflow will follow the standard Global Notices process including sending copies of notices to verified Authorized Representatives.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 25 of 163

2 Conceptual Flows

The flows captured within this section provide a high-level overview of the processes. Please refer to the functional section for detailed requirements.

2.1 SCDHEC Date of Death (DOD) File – Processing

in the ESB and Cúram

This process flow describes the high-level process flow for SCDHEC Date of Death (DOD) file processing in the ESB and Cúram.

2.1.1 SCDHEC Date of Death (DOD) File – Processing in the

ESB and Cúram Narrative

# Task/Process Task ID Narration

1. DHEC DOD Processing in ESB and Cúram

1 Process Flow Title

2. Receive Daily File From

DHEC

1.1 The ESB receives the daily DOD files from DHEC.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 26 of 163

# Task/Process Task ID Narration

3. Perform Pre-Processing & Validation

1.2 The ESB performs pre-processing and data

validation on the incoming DHEC DOD file.

The ESB determines if the data meets the validation criteria. The system will not accept a DOD record for a person where the DOD is greater than the current date.

The system will exclude records with any of the following SSA indicators:

1. FAILSSN

2. FAILGENDER

3. FAILDOB

4. FAILDOBGENDER

5. FAILNAME.

The recs that do not meet the validation criteria are excluded from further processing.

4. Generate Data Validation Reports

1.2, 1.25 Exception and Control reports are generated for records that fail validation. End of process.

5. Transmit Valid Records To Cúram

1.2, 1.3 The ESB sends all valid SCDHEC records to Cúram for further processing.

6. MEDS Check Call 1.3, 1.4 The ESB checks MEDS using Social Security Number to determine if the person has a record in

MEDS.

8. Person Search and Match 1.5 Cúram performs the Person Search and Match process to identify and determine if the person exists in Cúram.

9. Person Search and Match:

Conclusive Match? Yes

1.6, 1.7 A Conclusive Match will include Gender, verified Social Security Number (SSN), and Date of Birth

(DOB).

Cúram checks to see if there is an Open Integrated Case (IC) for the deceased person, if there is a Conclusive Match.

10. Person Search and Match:

Conclusive Match? No

Exception Report No Match & Inconclusive

1.6,1.24 A No Match or Inconclusive Match report is generated if there is either a No Match or an Inconclusive Match for the person. End of process.

11. Open IC? Yes

Person Currently Eligible?

1.7,1.8 Cúram determines if the person is eligible and receiving benefits on an open IC.

12. Open IC? No

External Source DOD Present?

1.7, 1.23 Cúram determines if the DOD was reported by any other external source before. External sources are MMA, SDX, BENDEX, SVES and Buy-In.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 27 of 163

13. Open IC? No

External Source DOD Present? No

1.23, 1.10 Cúram updates the DOD on the Birth and Death Details IC and Person Evidence, if the person is not on an open IC and the DOD was not reported by another external source.

14. Open IC? No

External Source DOD Present? Yes

1.23, 1.18 Cúram records the SCDHEC DOD, if the person is not on an open IC and the DOD was reported by another external source.

15. Open IC? Yes

Person Currently Eligible?

No

1.7, 1.8, 1.19

Cúram determines if the DOD is present in the system, if the person is on an open IC and currently ineligible.

16. Open IC? Yes

Person Currently Eligible?

Yes

1.7, 1.8, 1.9 Cúram determines if the DOD is present in the system, if the person is currently eligible.

17. Open IC? Yes

Person Currently Eligible?

No

DOD Present? No

1.8, 1.19, 1.21, 1.10

Cúram records the SCDHEC DOD, if the person is on an open IC and currently ineligible and the DOD is not present.

18. Open IC? Yes

Person Currently Eligible?

No

DOD Present? Yes

1.8, 1.19, 1.20

Cúram determines if the DOD was reported by an external source, if the person is on an open IC and currently ineligible and the DOD is present.

External sources are MMA, SDX, BENDEX, SVES and Buy-In.

19. External Source DOD Present? Yes

1.22 Cúram records the SCDHEC DOD if the DOD was

reported by an external source. No further action is required for this person.

20. External Source DOD Present? No

1.22, 1.10 Cúram records the SCDHEC DOD on the Birth and Death Details IC and Person evidence, if the DOD was not reported by an external source.

21. Person Currently Eligible?

Yes

Is the DOD present in the system: No

1.8, 1.9, 1.10

Cúram updates the Birth and Death Details DOD for the deceased member. CGIS end dates the Household Member evidence.

22. Person Currently Eligible?

Yes

Is the DOD present in the system: Yes

Is 30 Day Timer Active? Yes

1.8, 1.9, 1.10

Cúram sets the SCDHEC DOD as the correct DOD for the person on the case. CGIS closes the 30- Day Timer and updates the Birth and Death Details Date of Death.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 28 of 163

24. Person Currently Eligible?

Yes

Is the DOD present in the system: Yes

Is 30 Day Timer Active? No

1.9, 1.20 Cúram records the person’s SCDHEC DOD. No further action will be taken on the case.

25. Estate Recovery Subprocess 1.18, 1.18.1 Estate Recovery Subprocess detailed later in this document.

26. HCR or CGIS IC? 1.11 Cúram will end date different case evidence depending on the type of IC. CGIS will end date Household Member and HCR will end date Application Details.

27. Household Member Evidence End Date

1.12 CGIS updates the ‘End Date’ on the Household

Member evidence.

28. Application Details Evidence End Date and End Reason

1.19 HCR updates the ‘End Date’ and ‘End Reason’

(Deceased) on of the Application Details evidence.

28. OOTB Task To Close Remaining Evidences

1.13 CGIS generates an OOTB task that instructs the

worker to manually close additional Integrated Case evidences, once the ‘Household Member’ evidence update is applied,

29. Assign New Primary Contact Subprocess

1.14, 1.14.1 Assign New Primary Contact Subprocess detailed later in this Section 4.8 of this document.

30. Reassess Case 1.15 CGIS applies the Integrated Case evidence changes, which initiates a case reassessment.

31. Terminate Deceased Member Eligibility

1.16 Cúram determines the eligibility end-date for the

deceased person. The deceased member’s benefits end on the last day of the month that their DOD is processed by Cúram.

32. Generate Notice 1.17 Cúram generates notices once the case reassessment is completed as per the Global Notices process. Notices will be uploaded to OnBase.

33. Estate Recovery Subprocess 1.18, 1.18.1 Estate Recovery Subprocess detailed later in this document.

2.2 SCDHEC Date of Death (DOD) File – DOD

Reported Through Secondary Sources

CGIS18 DHEC Date of Death (DOD) V1.0 Page 29 of 163

2.2.1 SCDHEC Date of Death (DOD) File – DOD Reported

Through Secondary Sources Narrative

# Task/Process Task ID Narration

1. DOD Reported Through Secondary Source 1.0 Process Flow Title

The process begins when a DOD is reported through a secondary external source such as MMA, SDX, BENDEX, SVES and Buy-In.

2. DOD Already Exists? Yes 1.1 Cúram checks if the DOD already exists for the person. CGIS stores the record if the DOD already exists No further action is taken.

3. DOD Already Exists? No 1.1, 1.2 Cúram checks if the DOD already exists for the person. Cúram updates an ‘In

Edit’ Birth and Death Details evidence on the Integrated Case.

4. 30 Day Timer Subprocess 1.3, 1.31 30 Day Timer detailed in Section 3.2.2 later in this document.

5. Timer Expired? Yes 1.4 Cúram generates the Notice of Deceased

Beneficiary, when the 30-Day Timer to receive the DHEC DOD expires. The member’s eligibility is not be terminated yet.

6. Timer Expired? No 1.4 Case status does not change until timer expires. No further processing.

7. Generate ‘Notice of Deceased Beneficiary’ 1.5 Cúram generates notice per the existing

Notices process.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 30 of 163

8. Copy Of Notice Stored In OnBase 1.6 Copy of the notice is stored in OnBase.

9. 15-Day Timer Subprocess 1.7, 1.71 Cúram starts the 15-Day Timer after the

‘Notice of Deceased Beneficiary’ status is set to ‘Sent’.

11. Timer Expired? Yes 1.8, 1.9 Cúram begins the termination process for the deceased member.

12. Timer Expired? No 1.8 No further processing.

13. Activate DOD Birth and Death Details 1.9 Cúram updates the DOD on the Birth and

Death Details for IC and Person, once the

15-Day Timer has expired.

14. End Date Household Member Evidence 1.10 CGIS updates the End Date on the

Household Member evidence.

15. Assign Primary Contact sub flow 1.11, 1.11.1 This sub flow describes how CGIS selects a new Primary Contact if there is more than 1 person on the Integrated Case.

16. Reassess Case 1.12 Cúram applies the IC evidence changes, which causes a case reassessment. CGIS does not apply Adverse Action rules to the deceased member. CGIS runs adverse action rules for any remaining active household members on the case.

17. Terminate Deceased Member Eligibility 1.13 Cúram ends the deceased member’s eligibility on the last day of the month that the Date of Death is processed.

18. Generate Closure Notices 1.14 Cúram generates closure notices once the case reassessment is complete.

19. Copy of Notice Stored In OnBase 1.15 A copy of the closure notice is stored in

OnBase per the standard process.

19. Generate the estate recovery report. 1.16, 1.16.1 Cúram checks if the member meets the estate recovery criteria based on the person’s eligibility history. Estate recovery criteria are discussed in the

Reports section of this document.

2.2.2 Secondary Sources 30 Day Timer To Receive SCDHEC

DOD Expiry

CGIS18 DHEC Date of Death (DOD) V1.0 Page 31 of 163

2.2.2.1 Secondary Sources 30 Day Timer To Receive

SCDHEC DOD Expiry Narration

# Task/Process Task ID Narration

1. Secondary Sources 30 Day Timer To

Receive SCDHECDOD

1 Process Title

2. DOD Received Through Secondary

Source

1.1 The process begins when a DOD is reported through a

secondary external source such as MMA, SDX, BENDEX, SVES and Buy-In.

Buy-In DOD is defaulted to the last day of the month so if it is the only DOD received so far, any other incoming secondary DOD should replace that. Timers should not be extended due to this update. Also, additional new notices should not be triggered as a result.

3. Update DOD On Birth & Death Details

IC Only

1.2 Cúram stores the secondary source DOD Birth and

Death Details evidence as ‘In Edit’ on the IC. CGIS does not share the Birth and Death Details evidence update with the Person record at this point.

4. 30 Day Timer Start 1.3 Cúram starts the 30-Day SCDHEC DOD timer on the

IC.

5. SCDHEC DOD received within 30-day period?

1.4 Cúram will terminate benefits if the SCDHEC DOD is

received within the 30-day period.

Cúram generates a notice to the member’s household to confirm the member is deceased if the SCDHEC DOD is not received within the 30-day period.

6. Terminate benefits per SCDHEC DOD

Flow

1.5 Cúram terminates the deceased member’s benefits on

the last day of the month in which the Date of Death is processed.

7. Generate Notice Of Deceased

Beneficiary

1.6 “Notice of Deceased Beneficiary” is sent to the member’s household for confirmation of death.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 32 of 163

8. 15-day Timer Start 1.7 Once the notice is sent, a 15-day timer is started. If there is no response from the member’s household after

15-day + 5-day grace period, the system will terminate benefits in accordance with the SCDHEC DOD rules.

The deceased member’s benefits will be terminated immediately after the 15-day + 5-day grace period deadline. Adverse action rules will be applied to any remaining household members active on the IC. The existing checklist process for notices handles the 5-day grace period and should be leveraged for this.

2.2.3 Secondary Sources 15-Day Timer To Receive

Confirmation of Deceased Member

2.2.3.1 Secondary Sources 15-Day Timer To Receive

Confirmation of Deceased Member Narration

# Task/Process Task ID Narration

1. Secondary Sources 15-Day Timer To

Receive Confirmation of Deceased

Member

1 Process Title

2. Generate Notice Of Deceased

Beneficiary

1.1 CGIS generates the “Notice of Deceased

Beneficiary”.

3. 15-Day Timer Starts 1.2 CGIS starts a 15-day timer when the notice status is set to ‘Sent’.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 33 of 163

5. Terminate Benefits Per SCDHEC DOD

Flow

1.3 CGIS runs the timer for 15 calendar days.

Once the timer expires + 5-day grace period, CGIS starts the termination of benefits.

CGIS ends the deceased members benefits at the end of the month that the Date of Death is processed. CGIS will send a notice, if there are family members that remain on the case and their eligibility is impacted.

CGIS closes the 15-Day + 5-day grace period timer and terminates the Medicaid eligibility for the deceased person if the SCDHEC DOD is received during the 15-day + 5-day grace period timer.

CGIS will update the Person Birth and Death

Details evidence once the DHEC DOD is received or the 15-day timer secondary source timer expires. Eligibility rules are tied to this

Person evidence.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 34 of 163

3 Requirements Matrix

This section provides the references to the Requirement Traceability Matrix (RTM.) The spreadsheet to upload the requirements to Jira is stored on SCDHHS MMRP SharePoint as

MMRP CGIS 18 SCDHEC DOD Interface ADD RTM.

This section will document any subsequent changes to the RTM that may later be required as discovered through development, test execution, bug fix develop or training activities.

3.1 Requirement Modifications – N/A

This section will document any subsequent changes to the RTM that may later be required as discovered through development, test execution, bug fix develop or training activities.

Note: This section is used to highlight requirement changes, changes required to be addressed in by this design will be included in the Function Section as well as the RTM document and Jira.

Requirement

ID

Business Rule

ID

Description System Feature

Date Updated

In Scope (Yes or No) https://team.scdhhs.gov/pmo/ProjectRepository/1211207/_layouts/xlviewer.aspx?id=/pmo/ProjectRepository/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/MMRP%20CGIS%2018%20DHEC%20DOD%20Interface%20ADD_RTM.xlsx&Source=https%3A%2F%2Fteam%2Escdhhs%2Egov%2Fpmo%2FProjectRepository%2F1211207%2FCGIS%2520Business%2520Requirements%2520and%2520Design%2520Documents%2FForms%2FAllItems%2Easpx%3FGroupString%3D%253B%2523CGIS18%2520DHEC%2520DOD%2520Interface%253B%2523In%2520Progress%253B%2523%26IsGroupRender%3DTRUE&DefaultItemOpen=1&DefaultItemOpen=1

CGIS18 DHEC Date of Death (DOD) V1.0 Page 35 of 163

4 Functions

This section describes the details of the system functionality.

4.1 SCDHEC Date of Death (DOD) File Processing in

the ESB

The purpose of this function is to receive the daily SCDHEC Date of Death (DOD) file in the

ESB, validate the content, and determine if the records can be processed further in Cúram.

4.1.1 Design Description

This story describes how SCDHEC will submit the Date of Death file via the Enterprise Service

Bus (ESB). Validation checks will be performed on the file to ensure data integrity. Records that fail validation will be included in an exception report (further details in Reports).

4.1.2 Functional Output

1. SCDHEC sends a daily SCDHEC Date of Death (DOD) file to SCDHHS via the ESB.

2. ESB receives the SCDHEC DOD file and performs the data validation as per the pre-defined rulesets.

3. The ESB generates the applicable exception and control reports.

4. The ESB transmits the valid SCDHEC records to Cúram for further processing.

4.1.3 Design Details

Requirement ID Requirement Details

DOD_REQ_1.0 ESB receives the daily SCDHEC file that contains the person death information. Failure of file submission to the ESB will be handled through the current manual process.

DOD_REQ_1.1 ESB completes record level validations per the requirements below.

DOD_REQ_1.1.1 ESB excludes records with any of the following SSA indicators:

1. FAILSSN

2. FAILGENDER

3. FAILDOB

4. FAILDOBGENDER

5. FAILNAME

DOD_REQ_1.1.2 ESB marks all the records that pass data validation with the SSA indicator of ‘PASSED’.

DOD_REQ_1.1.3 ESB does not send any records to CGIS where the ‘Date of Death’ is greater than the current date or an invalid format.

DOD_REQ_1.1.4 ESB does not send any records to CGIS where the ‘Descendent Social Security Number’ is not a 9-digit number and or starts with ‘9’.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 36 of 163

Requirement ID Requirement Details

DOD_REQ_1.1.5 ESB does not send any records to CGIS where the ‘First Name’ has non alpha characters with the exception of – and ‘.

DOD_REQ_1.1.6 ESB does not send any records to CGIS where the ‘Last Name’ has non alpha characters with the exception of – and ‘.

DOD_REQ_1.1.7 ESB does not send any records to CGIS where the ‘Date of Birth’ is greater than the current date or an invalid format.

DOD_REQ_1.1.8 ESB does not send any records to CGIS where the ‘Gender” is not ‘M’, ‘F’, or ‘U’.

DOD_REQ_1.2 The system (CGIS and HCR) uses Person Search and Match (SSN, Gender, DOB) to determine if SCDHEC reported deceased members who have a record in Cúram.

DOD_REQ_1.2.1 The system (CGIS and HCR) performs the Person Search and Match process in Cúram for the SCDHEC records that are screened out through the exception process. A Conclusive Match for DHEC will include Verified Social Security Number (SSN), Gender, and Date of Birth (DOB).

DOD_REQ_1.3 The system (CGIS and HCR) continues processing the records if the deceased person is a Conclusive match in Cúram

DOD_REQ_1.3.1 The system (CGIS and HCR) excludes the SCDHEC record from further processing if it is a No Match in Cúram.

DOD_REQ_1.3.2 The system (CGIS and HCR) excludes the SCDHEC record from further processing if it is an Inconclusive Match in Cúram.

DOD_REQ_1.4 The system (CGIS and HCR) utilizes a Date of Death interface screen in the Person record on the worker portal to store and display the DOD for a person reported deceased.

DOD_REQ_1.4.1 The system (CGIS and HCR) Date of Death interface screen displays SCDHEC DOD as well as the other authorized secondary sources.

DOD_REQ_1.4.2 The DOD interface screen on the Person record displays the following information for each reported source:

1. Person First and Last Name

2. SSN

3. Date of Birth

4. Date of Death

5. Source Name

6. Reported Date

DOD_REQ_1.4.3 The system (CGIS and HCR) allows workers with security rights to the Date of Death Interface screen to view all of the information displayed on the page

DOD_REQ_1.4.3.1 The system (CGIS and HCR) allows workers with security rights to the Date of Death Interface screen to view all of the information displayed on the DHEC Inbound Data Response page.

DOD_REQ_1.4.4 The system (CGIS and HCR) will display the most recent DHEC DOD record processed by Cúram

CGIS18 DHEC Date of Death (DOD) V1.0 Page 37 of 163

DOD_REQ_1.4.5 The system (CGIS and HCR) will display the most recent secondary source DOD record processed by Cúram. Only secondary sources reporting a DOD will be contained on this screen.

DOD_REQ_1.4.6 When the DOD is reported by Buy-In, the system will set the DOD per the following:

1. If the report is from the previous month, the system will set the DOD to the last day of the past month.

2. If the report is the current month, it will be set to the date of the report.

4.1.4 Screen Flow Worker Portal Date of Death Interface

Response Screen

Legend

4.1.4.1 Screen Flow Narrative

4.1.5 Screen Mockups

4.1.5.1 Screen: DHEC Interface Response Screen (NEW)

This screen displays the most recent Date of Death information processed by Cúram. The DHEC file information can be viewed through an action control on this screen. Additional secondary source file information is contained in the specific interface screen.

CGIS18 DHEC Date of Death (DOD) V1.0 Page 38 of 163

Fig: DHEC Interface Data – Most Recent Inbound Response Screen

4.1.5.2 Screen: DHEC Inbound Response (NEW)

Fig: DHEC Inbound Data Response

CGIS18 DHEC Date of Death (DOD) V1.0 Page 39 of 163

4.1.6 Business Rules – N/A

4.1.7 User Roles

Refer to User Roles Spreadsheet.

4.1.8 Data Fields – N/A

4.1.9 Links – Navigation – N/A

4.1.10 Links – Functions/Actions – N/A

4.1.11 Validations – N/A

4.1.12 Notifications and Tasks – N/A

4.1.13 Other – N/A

4.2 Birth and Death Details Evidence

The purpose of this function is to record the date of death for the deceased member to be used in

Medicaid rules processing. ‘Birth and Death Details’ evidence exists on the Integrated Case and

Person record. The ‘Birth and Death Details’ Integrated Case evidence will be updated first upon receipt of ‘Date of Death’ (DOD) information from SCDHEC or secondary sources. Once the system applies changes, the ‘Date of Death’ (DOD) will be shared from the Integrated Case to the Person Record per the AES Configurations.

4.2.1 Design Description

This story describes how the ‘Birth and Death Details’ evidence for Integrated Cases and Person will behave for ‘Date of Death’ records received through a Cúram interface.

4.2.2 Functional Output

1. SCDHEC or a Secondary Source sends a ‘Date of Death’ (DOD) to Cúram via the ESB.

2. Cúram performs a Person Search and Match. If a conclusive match is found, a ‘Birth and

Death Details’ Integrated Case evidence is updated.

3. Cúram receives a DOD reported by DHEC then the ‘Birth and Death Details’ IC evidence is activated. The ‘Birth and Death Details’ IC evidence reported by DHEC is shared with the

Person record upon activation.

4. Cúram receives a DOD from a Secondary Source, the ‘Birth and Death Details’ IC evidence remains ‘In Edit’ until the 15-day timer expires. Once the 15-day timer closes, the ‘Birth and

Death Details’ IC evidence activates and is shared with the Person record.

5. Cúram will display new ‘Change Reason’ dropdown values on the “Edit Birth and Death

Details” screen to reflect the particular interface that reported the change.

https://schhs.sharepoint.com/:x:/r/sites/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/Combined%20Workspace%20for%20SCMMRP%20UserRoles%20v1.3.xlsx?d=wc8fcf7a234ea4ef584ff641bac04a8d2&csf=1&web=1&e=Q1pft9

CGIS18 DHEC Date of Death (DOD) V1.0 Page 40 of 163

6. Cúram shares a DOD entered directly on the Person ‘Birth and Death Details’ evidence with the existing Integrated Case(s). The updated Person ‘Birth and Death Details’ evidence comes over as a ‘Trusted Source’ entry. The worker does not need to take any action as it will be activated automatically.

4.2.3 Design Details

DOD_REQ_2.0 The system (CGIS and HCR) allows authorized users to manually update the DOD on the ‘Birth and Death Details’ Person Record evidence

DOD_REQ_2.1 The system (CGIS and HCR) requires a comment to be entered whenever the existing ‘Birth and Death Details’ DOD is manually updated by a worker

DOD_REQ_2.1.1 The system (CGIS and HCR) displays the error message “Please provide a brief description to explain the change in the person Date of Death” if a worker attempts to save changes on the ‘Birth and Death Details’ IC and/or Person evidence without a comment.

DOD_REQ_2.1.2 The system (CGIS and HCR) copies the manually entered worker comment from the IC to the person record and vice-versa once the evidence is activated and subsequently shared.

DOD_REQ_2.1.3 The system (CGIS and HCR) populates the comment “Date of Death <MM/DD/CCYY> reported for <person first and last name> by the <source name (DHEC/SDX/BENDEX/Buy-In/SVES/MMA)> verification system on <MM/DD/CCYY>.” in the comments section of the ‘Birth and Death Details’ evidence on the open IC when the DOD updates through an external source.

Note: SVES functionality will be implemented after Release 2 and is not in scope for R1 or R2.

DOD_REQ_2.1.43 The system (CGIS and HCR) sets the last day of the month the change is applied as the eligibility end date for the deceased person.

DOD_REQ_2.1.5 The system (CGIS and HCR) does not apply adverse action rules when the eligibility terminates for the deceased person.

DOD_REQ_2.1.5.1 The system (CGIS and HCR) applies adverse action rules when ending the eligibility for any remaining household members on the case.

DOD_REQ_2.1.6 Once the ‘Birth and Death Details’ IC evidence is active, the system (CGIS and HCR) the updates will share to the Person Record per the AES configurations.

DOD_REQ_2.1.6.1 CGIS updates the Date of Death on the ‘Birth and Death Details’ and the

End Date on the ‘Household Member’ IC evidence once the person’s eligibility is to be terminated.

DOD_REQ_2.1.6.1.1

The End Date of the CGIS ‘Household Member’ evidence will be the last day of the batch processing month

CGIS18 DHEC Date of Death (DOD) V1.0 Page 41 of 163

DOD_REQ_2.1.6.2 HCR updates the Date of Death on the ‘Birth and Death Details’ and the

End Date and End Reason on the ‘Application Details’ IC evidence once the person’s eligibility is to be terminated.

DOD_REQ_2.1.6.2.1

The End Date of the HCR ‘Application Details’ evidence will be the last day of the batch processing month.

DOD_REQ_2.1.6.2.2

The End Reason of the HCR ‘Application Details’ evidence will be

‘Deceased’.

DOD_REQ_2.1.7 The system (CGIS and HCR) will allow the Case Workers to remove the

Date of Death on the Birth and Death details evidence if the DOD was reported in error.

DOD_REQ_2.1.7.1 The system (CGIS and HCR) will check for timers associated with the

DOD when the case worker performs Apply Changes and will stop any active timers.

DOD_REQ_2.1.8 CGIS will allow the Case Worker to remove the ‘Household

Member’ evidence End Date on the CGIS IC evidence if the DOD was reported in error.

DOD_REQ_2.1.9 HCR will allow the Case Worker to remove the ‘Application Details’ evidence End Date and End Reason on the HCR IC evidence if the DOD was reported in error.

DOD_REQ_2.1.10 If the member has active ‘Non-MAGI Manual Eligibility’ evidence, CGIS will set the End Date to the last day of the batch…