South Carolina Department of Health and Human Services

(SCDHHS)

Member Management Replacement Program (MMRP)

Cúram Global Income Support (CGIS) Project

Architectural Description Document

(ADD)

CGIS36 State Data Exchange (SDX) Interface

MMRP CGIS Project ADD Page 2 of 477 CGIS36 SDX Interface v3.0

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 9/26/2018 Chris LiPuma Business

Analyst Initial Draft

0.2 11/1/2018 Sandeep

Burman Technical Lead

Revised Draft

0.3 11/13/2018 Ken Haas Functional

Business Lead

QA Content Review. Format standardization will be completed for Approval

0.4 12/31/2018 Vamshi

Vankadara Developer TDS Section Added

0.5 01/11/2019 Vamshi

Vankadara Developer TDS Review Comments resolution

0.6 2/7/2019 Chris LiPuma Business

Analyst Solution for SSCN & MCN Processing

CGIS_SDX_106

CGIS_SDX_106.1

CGIS_SDX_106.2

CGIS_SDX_106.2.1

CGIS_SDX_106.2.2

CGIS_SDX_106.2.3

CGIS_SDX_106.3

CGIS_SDX_106.3.1

CGIS_SDX_106.3.2

CGIS_SDX_106.3.3

0.7 2/11/2019 Vamshi

Vankadara Developer 6.5.11.1 (Termination)

6.5.11.2 (Transaction Code 03)

6.5.11.6 (Eligible code)

6.5.12.3.1 (Prospect Match)

6.5.12.4 (Curam Processing Flow)

6.5.12.5 (Record Level Validations)

6.5.12.7 (Eligibility Begin end Date processing)

6.5.12.8 (Other code processing)

MMRP CGIS Project ADD Page 3 of 477

Version Date Drafted by Role Description of Change

0.8 2/14/2019 Chris LiPuma Business

Analyst Termination Code - Ex Parte Timer Updated:

CGIS_SDX_5.1

Added:

CGIS_SDX_5.5

CGIS_SDX_5.5.1

CGIS_SDX_5.5.2

CGIS_SDX_5.5.3

Ex Parte - Ex Parte Timer Added:

CGIS_SDX_32.2.3

CGIS_SDX_32.2.4

CGIS_SDX_32.2.5

CGIS_SDX_32.2.6

Prospect Match Updated:

CGIS_SDX_4.3

Field Level Validations Updated:

CGIS_SDX_1.2

Added:

CGIS_SDX_1.2.1

CGIS_SDX_1.2.2

Citizenship Added:

CGIS_SDX_36.1

Closure Notice Generation Updated:

CGIS_SDX_30

CGIS_SDX_30.1

CGIS_SDX_30.2

CGIS_SDX_30.3

Pending Application Updated:

CGIS_SDX_25

0.9 2/20/2019 Chris LiPuma Business

Analyst Updated FDS & TDS based on State review comments.

Addressed all State review comments. Updated open items.

Added details related to evidence updates -

CGIS_SDX_4.7

Added details related to new case creation -

CGIS_SDX_6.1.2

0.10 3/1/2019 Vamshi

Vankadara Developer Resolved following TDS Action Items.

1070 (6.5.12.9) - Residential Address Default, 1075 (6.5.11.10, 6.5.11.11) - 503 lead and pickle notice,1077 (6.5.11.11) - Pickle file address parsing, 1078 (6.2.1) - Unit test cases, 1079 (6.5.24) - Task Type Code Table values

MMRP CGIS Project ADD Page 4 of 477

Version Date Drafted by Role Description of Change

0.11 3/3/2019 Chris LiPuma Business

Analyst Updated 503 Leads and Pickle sections to remove person registration details and to generate notices using SDX record information as per AI 1075.

0.12 3/24/2019 Chris LiPuma Business

Analyst Updates from QA review for final acceptance submission

0.13 3/25/2019 Sumanth

Prasad Business Analyst

Made Formatting Changes

V1.0 4/1/2019 Erin Coleman SCDHHS

Process & Artifact Development Manager

Updated version number, watermark, and approval date.

V1.1 4/21/2019 Amir Iqbal Business

Analyst Updated the functional design for CR23.

Following requirements added or updated.

Added sub requirement CGIS_SDX_4.7.1 Added a note to CGIS_SDX_5 Added CGIS_SDX_5.6 and its sub requirements Added Note to CGIS_SDX_7 Added CGIS_SDX_7.2 and its sub requirement Updated CGIS_SDX_16.1 Deleted the requirement CGIS_SDX_16.3 Updated CGIS_SDX_17.1 Corrected the number for CGIS_SDX_17.3 Deleted the requirement CGIS_SDX_17.4 Updated CGIS_SDX_18 Added sub requirement to 18.1 Updated CGIS_SDX_23 Added sub requirements to CGIS_SDX_23 Added CGIS_SDX_29.1 Added SDX_COLA_9.1.1 Use cases added in the use case section.

V1.1 5/9/19 Amir Iqbal Business

Analyst Updated for state first round of comments.

V1.2 5/20/19 Amir Iqbal Business

Analyst Updated for state second round comments.

MMRP CGIS Project ADD Page 5 of 477

Version Date Drafted by Role Description of Change

V1.3 6/12/19 Amir Iqbal Business

Analyst Updated following for state final comments.

CGIS_SDX_4.7.1.1

CGIS_SDX_4.7.2

CGIS_SDX_18.1.1

CGIS_SDX_18.1.2

CGIS_SDX_18.1.3

CGIS_SDX_18.1.4

CGIS_SDX_23.1.2

6.5.12.9

V1.4 6/17/19 Amir Iqbal Business

Analyst Corrected the Appendix letters, there were two sets of Appendix A-D. Fixed the appendix letters, letters for following appendices.

Appendix A: SDX Record Layout renamed to Appendix E: SDX Record Layout

Appendix B: SDX Work queue Requirement renamed to Appendix F: SDX Work queue Requirement

Appendix C: SDX Data to Evidence Mapping renamed to Appendix G: SDX Data to Evidence Mapping

Appendix D: SDX Data Field Level Validations renamed to Appendix H: SDX Data Field Level Validations

V1.5 6/26/19 Vamshi

Vankadara Developer Updated the technical design for CR23.

Corresponding FDS Changes mentioned in brackets.

Updated Sequence Diagrams in TDS Sections

6.5.11.1 (CGIS_SDX_5.6), 6.5.11.3

(CGIS_SDX_7.2), 6.5.11.6 (Second part, CGIS_SDX_16.1, CGIS_SDX_17.1, CGIS_SDX_23), 6.5.11.7 (CGIS_SDX_29.1),

6.5.11.9 (SDX_COLA_9.1.1), Updated 6.5.12.9

(CGIS_SDX_4.7.1, CGIS_SDX_4.7.2), 6.5.12.7

(CGIS_SDX_18.1)

MMRP CGIS Project ADD Page 6 of 477

Version Date Drafted by Role Description of Change

V1.6 7/3/19 Chris LiPuma IBM

Business Analyst

Updated per CGIS36 SDX CR59 and CGIS29 MMA Interface CR032

1) CGIS36 SDX CR59:

Updated ‘COLA Functional Output’ Section

CGIS_SDX_63

CGIS_SDX_82

SDX_COLA_3.3

SDX_COLA_4

Added

SDX_COLA_3.3.1

SDX_COLA_3.3.2

2) CGIS29 MMA Interface CR032:

Updated

CGIS_SDX_106.2.2

CGIS_SDX_106.3

CGIS_SDX_106.3.1

CGIS_SDX_106.3.3

Added

CGIS_SDX_106.3.4

CGIS_SDX_106.3.5

V1.7 7/9/19 Vamshi

Vankadara Developer Updated the technical design for CR59.

Corresponding FDS Changes mentioned in brackets.

Updated Sequence Diagrams in TDS Sections

6.5.11.9 (CGIS_SDX_3.3), 6.5.11.10

(CGIS_SDX_63), 6.5.11.11 (CGIS_SDX_82)

Updated the technical design for CGIS29 MMA Interface CR032. Changes mentioned in TDS section 6.5.12.9(Identification Evidence)

V1.8 7/9/19 Chris LiPuma IBM

Business Analyst

Inserted comments in FDS with proposed changes as part of CR65. Comments can be identified by searching ‘CR65’.

V1.8 7/10/19 Amir Iqbal Business

Analyst Updated based on CR23 technical review comments.

Added a note into CGIS_SDX_7.2 Added two notes into the section 6.5.12.9

MMRP CGIS Project ADD Page 7 of 477

V1.9 8/12/19 Chris LiPuma IBM

Business Analyst

Updated the following requirements per CR65:

CGIS_SDX_4.1

CGIS_SDX_4.3

CGIS_SDX_4.3.1

CGIS_SDX_4.6.1

CGIS_SDX_4.6.2

CGIS_SDX_6.1.3

CGIS_SDX_7.1

CGIS_SDX_10

CGIS_SDX_10.3

CGIS_SDX_16.2.2

CGIS_SDX_17.2

CGIS_SDX_17.3.1

CGIS_SDX_19.1

CGIS_SDX_19.3

CGIS_SDX_20

CGIS_SDX_20.1.3

CGIS_SDX_21.2.1

CGIS_SDX_22.2

CGIS_SDX_27.1

CGIS_SDX_29

CGIS_SDX_32.2.1

Deleted CGIS_SDX_37

SDX_COLA_3.1

CGIS_SDX_90

CGIS_SDX_101.1

CGIS_SDX_9

CGIS_SDX_16.2

CGIS_SDX_20.1

CGIS_SDX_20.1.1

CGIS_SDX_20.1.2

Deleted CGIS_SDX_20.2 Deleted CGIS_SDX_20.2.1 Deleted CGIS_SDX_20.2.2 Deleted CGIS_SDX_20.2.3 Deleted CGIS_SDX_20.2.4

CGIS_SDX_21

CGIS_SDX_21.1

CGIS_SDX_24

CGIS_SDX_35

CGIS_SDX_52.1

CGIS_SDX_69

CGIS_SDX_67

CGIS_SDX_86

CGIS_SDX_87

CGIS_SDX_87.1

CGIS_SDX_89

SDX_RPT_8.2

SDX_RPT_9.2

CGIS_SDX_91

SDX_RPT_12.2

CGIS_SDX_RPT_13

SDX_RPT_13.2

CGIS_SDX_95

MMRP CGIS Project ADD Page 8 of 477

Version Date Drafted by Role Description of Change

CGIS_SDX_RPT_14

SDX_RPT_14.2

CGIS_SDX_96

CGIS_SDX_RPT_15

CGIS_SDX_RPT_16

CGIS_SDX_97

CGIS_SDX_98

CGIS_SDX_RPT_17

SDX_RPT_19.2

CGIS_SDX_42

CGIS_SDX_RPT_5

CGIS_SDX_43

CGIS_SDX_RPT_6

v1.10 12/19/2019 Tiffany Ortega

IBM

Functional Consultant

Updates per CR168:

Updates to Appendix E: SDX Record Layout

- #62 from Numeric to Alpha per #1 in

CR168

- #300 to include Special Characters per #2 in CR168

- #225, #231, #237, #243, #249, #261, #267, #273, and #284 to include Special Characters per #4 in CR168

- #304 to include Numeric values per #6 in

CR168

Updated CGIS_SDX_71 per #3 in CR168

V1.11 2/12/2020 Amir Iqbal

IBM

Functional Consultant

Updates per CR158 Selection criteria for following functional requirements updated.

CGIS_SDX_95

CGIS_SDX_96

CGIS_SDX_97

CGIS_SDX_99

CGIS_SDX_41

MMRP CGIS Project ADD Page 9 of 477

V1.12 2/13/2020 Amir Iqbal IBM

Functional Consultant

Updated for R14R2

Section 5.2

Added R2_CGIS_SDX_4.8, R2_CGIS_SDX_4.81

Section 5.3 T30/33 code Added R2_CGIS_SDX_5.7 and its sub req

R2_CGIS_SDX_5.8

Section 5.4 Move In / Out Added

R2_CGIS_SDX_6.1A

R2_CGIS_SDX_7 and its sub req

R2_CGIS_SDX_7.4

Task R2CGIS_SDX_TASK_9 added

Section 5.6 Eligible Code

R2_CGIS_SDX_10.6.1

R2_CGIS_SDX_11

R2_CGIS_SDX_12

R2_CGIS_SDX_13

R2_CGIS_SDX_14

R2_CGIS_SDX_15

R2_CGIS_SDX_TASK_10

R2_CGIS_SDX_TASK_11

R2_CGIS_SDX_TASK_12

R2_CGIS_SDX_TASK_13

Removed CGIS_SDX_11 to CGIS_SDX_15 R1 req for R2 PCATs

CGIS_SDX_TASK_2

Section 5.7 Ineligible code Added

R2_CGIS_SDX_29.2

R2_CGIS_SDX_30.4

R2_CGIS_SDX_32

Section 5.7 Ex-parte Added

R2_CGIS_SDX_33.1

R2_CGIS_SDX_34.1

R2_CGIS_SDX_35.1

Replaced the evidence mapping sheet in Appendix G with new approved version.

MMRP CGIS Project ADD Page 10 of 477

Version Date Drafted by Role Description of Change

V1.12.1 3/4/2020 Randhir/Vamshi

Vankadara Developer Updated the technical design for R14R2.

Updated Sequence Diagrams in TDS Sections Added the corresponding technical details.

Add corresponding JUNITS – 6.2.1 Cúram Unit Testing Scenarios

Section 5.2

Added R2_CGIS_SDX_4.8, R2_CGIS_SDX_4.8.1

Section 5.3 T30/33 code Updated 6.5.11.1

Section 5.4 Move In / Out Updated 6.5.11.3

Section 5.6 Eligible Code

6.5.11.12, 6.5.11.12.1 6.5.11.13, 6.5.11.13.1 6.5.11.14, 6.5.11.14.1 6.5.11.15, 6.5.11.15.1 6.5.11.16, 6.5.11.16.1 Updated 6.5.11.6- Crossed out the old sequence diagram for which the above new sequence diagrams added

Section 5.7 Ineligible code Updated 6.5.11.7

6.5.12.9.1 - Evidence creation/updation logic for release 2 PCATs

V1.13 3/6/2020 Amir Iqbal

Updated for CR200 Added following fields to section 5.15.7 Application Date Filing Date

MMRP CGIS Project ADD Page 11 of 477

Version Date Drafted by Role Description of Change

V1.14 3/11/2020 Tiffany Ortega IBM BA Lead Updated the following sections/requirements per

CR193:

1. 5.10.02 Functional Output

2. SDX_COLA_3

3. SDX_COLA_11.1

4. 5.11.2 Functional Output

5. CGIS_SDX_47.1

6. 5.12.2 Functional Output

7. CGIS_SDX_52

8. CGIS_SDX_52.1

9. 5.13.2 Functional Output

10. CGIS_SDX_72.2

11. CGIS_SDX_73

V1.15 3/25/2020 Amir Iqbal Business

Analyst Requirements added/updated as part of addressing cycle 1 comments.

Flow 3.6

R2_CGIS_SDX_4.8.1

R2_CGIS_SDX_5.7

R2_CGIS_SDX_5.8

R2_CGIS_SDX_7.3

CGIS_SDX_6.1.2

R2_CGIS_SDX_10.6.1

R2_CGIS_SDX_11

R2_CGIS_SDX_12

R2_CGIS_SDX_13

R2_CGIS_SDX_14

R2_CGIS_SDX_15

R2_CGIS_SDX_29.2

CGIS_SDX_31.1

CGIS_SDX_31.2

CGIS_SDX_33

CGIS_SDX_TASK_5

TDS section 6.5.12.9.1

V1.16 4/6/2020 Tiffany Ortega IBM BA Lead Updated the Note for CGIS_SDX_29 per CR220 related to CGISS-29128.

V1.17 4/7/2020 Vijay Makam IBM Tech Lead

Updated ESB Technical sections 6.3.1.3.5, 6.3.2.3.5,6.3.3.3.5,6.3.4.3.5,6.3.5.3.5 for CR 193

V1.18 5/11/2020 Amir Iqbal

Business Analyst

Updated for CR234. SDX COLA Exception report columns did not match with the actual report.

Added additional columns in the report requirement SDX_COLA_11.2 updated Defect associated CGISS-29787 https://cuihhsiutl10.clemson.edu:8443/browse/CGISS-29787

MMRP CGIS Project ADD Page 12 of 477

Version Date Drafted by Role Description of Change

V 1.19 5/21/2020 Vamshi Vankadara

IBM

Developer

DHEC R2 Updates :

6.5.12.9.1 Evidences Create/Update Logic -

Birth and Death Details Evidence - Updation

6.1.23 updateDeathEvidence API details added

V1.20 5/28/2020 Amir Iqbal

Business Analyst

Updated for CR237 , defect 30897.

Added a column “Record ID” in the report.

Following requirement updated

CGIS_SDX_RPT_1.2.

MMRP CGIS Project ADD Page 13 of 477

Version Date Drafted by Role Description of Change

V1.21 6/10/2020 Amir Iqbal Business

Analyst R14R2 Updates added/updated following requirements for cycle 2 comments.

3.6.1 Member on PCAT 10 or 33 and Eligible

Code Received

3.6.2 Member on PCAT 54 and Eligible Code

Received

3.6.3 Member on PCAT 86 and Eligible Code

Received

3.6.4 Member on PCAT 85 and Eligible Code

Received Requirements Added/Updated

R2_CGIS_SDX_4.8

R2_CGIS_SDX_4.9

R2_CGIS_SDX_5.1.1

R2_CGIS_SDX_5.1.2

R2_CGIS_SDX_5.2.1

R2_CGIS_SDX_5.2.2

R2_CGIS_SDX_5.3.1

R2_CGIS_SDX_5.3.2

R2_CGIS_SDX_5.3.3

R2_CGIS_SDX_5.3.4

R2_CGIS_SDX_5.3.5

R2_CGIS_SDX_5.4.1

R2_CGIS_SDX_5.4.2

R2_CGIS_SDX_5.4.3

R2_CGIS_SDX_5.7

R2_CGIS_SDX_5.8

R2_CGIS_SDX_6.1A

R2_CGIS_SDX_7.3

R2_CGIS_SDX_7.4

R2_CGIS_SDX_10.6.1

R2_CGIS_SDX_11

R2_CGIS_SDX_12

R2_CGIS_SDX_13

R2_CGIS_SDX_14

R2_CGIS_SDX_15

R2_CGIS_SDX_28

R2_CGIS_SDX_29

R2_CGIS_SDX_29.2

R2_CGIS_SDX_33.1

R2_CGIS_SDX_33.2

R2_CGIS_SDX_33.3

R2_CGIS_SDX_33.4

R2_CGIS_SDX_35

R2_CGIS_SDX_101

V1.22 6/20/2020 Tiffany Ortega IBM BA Lead Updated 5.15.7 Data Fields 48, 48A, 48B, 48C per CR229 and CGIS_SDX_21.2.3

MMRP CGIS Project ADD Page 14 of 477

Version Date Drafted by Role Description of Change

V 1.23 6/22/2020 Vamshi

Vankadara, Randhir Singh

IBM

Developer

Following Technical Design sections updated:

1. 6.1 Common Technical Artifacts – Code

Tables, Messages, Service Layer

2. 6.5.1.1 – T30/T33

6.5.1.3 – Transaction code 05

6.5.1.7 – Ineligible Codes

6.5.1.8 – Ex-parte/Reassessment

6.5.1.12 – All R2 PCATS processing logic

6.5.1.13 – PCATS 10, 33

6.5.1.14 – PCATS 54

6.5.1.15 – PCAT 85

6.5.1.16 – PCAT 86

6.5.1.17 – Evidence updates with back date logic for IC reuse.

V1.24 7/3/2020 Tiffany Ortega

IBM BA Lead Added the following requirements per CR249:

CGIS_SDX_32.2.2.1

CGIS_SDX_32.2.2.2

V1.25 7/8/2020 Amir Iqbal

Business Analyst

Updated for CR254

CGIS_SDX_90

CGIS_SDX_48

CGIS_SDX_21.1

V1.26 7/13/2020 Vamshi

Vankadara, Randhir Singh

IBM

Developer

Following Technical Design sections updated for Review Cycle 3:

1. 6.1 Common Technical Artifacts – Code Tables, Messages, Service Layer, Entity Layer

2. 6.5.1.1 – T30/T33

6.5.1.3 – Transaction code 05

6.5.1.7 – Ineligible Codes

6.5.1.8 – Ex-parte/Reassessment

6.5.1.13 – PCATS 10, 33

6.5.1.14 – PCATS 54

6.5.1.15 – PCAT 85

6.5.1.16 – PCAT 86

V1.27 7/23/2020 Amir Iqbal Business Analyst

Updated CGIS_SDX_92 for CR258

V1.28 7/30/2020 Tiffany Ortega IBM BA Lead Updated the template, formatting, spelling and grammar checks for formal approval.

V1.29 8/1/2020 Tiffany Ortega

IBM BA Lead Updated the work queue references to indicate the correct name of SDX MIM, SDX EW, and SDX LTC per CR260.

2.0 8/18/2020 Erin Coleman SCDHHS

Process & Artifact Development Manager

Updated version number, watermark, and approval date to reflect approval. Removed all comments and accepted track changes.

MMRP CGIS Project ADD Page 15 of 477

Version Date Drafted by Role Description of Change

2.1 8/20/20

Amir Iqbal IBM BA Updated for CR270, the purge report CGIS_SDX_93 removed. Purge process is not part of MMRP.

2.2 8/20/20 Amir Iqbal IBA BA Updated for the items listed in the email dated

7/22/20 from Abhishek.

Added R2_CGIS_SDX_16 and its sub req handle dual eligibility in the past

Updated R2_CGIS_SDX_TASK_13 task as per email point 1

Updated following req for diary date as per email point 2

R2_CGIS_SDX_4.8.5.2

R2_CGIS_SDX_4.8.5.3

R2_CGIS_SDX_4.8.5.4

R2_CGIS_SDX_4.8.5.5

Added R2_CGIS_SDX_16 for past dual eligibility for a member on R2 PCATs

2.3 9/8/2020 Amir Iqbal IBM BA Updated based on CR272, following requirements got updated

CGIS_SDX_RPT_1.1

SDX_COLA_13.3

CGIS_SDX_21.1

CGIS_SDX_43

2.4 9/23/2020

Amir Iqbal IBM BA Following updates made based on the discussion with state team in 9/15 meeting

Added following req

R2_CGIS_SDX_16.0.1

Updated following req

R2_CGIS_SDX_16

R2_CGIS_SDX_16.1

R2_CGIS_SDX_16.2.5.1

Example 3, under R2_CGIS_SDX_28.2.2 updated

2.5 10/7/2020

Amir Iqbal IBM BA Updated for CR284, following requirements got updated

CGIS_SDX_85.2

CGIS_SDX_TASK_1

2.6 10/12/2020 Amir Iqbal IBM BA Updated report names for CR295

MMRP CGIS Project ADD Page 16 of 477

Version Date Drafted by Role Description of Change

2.7 10/16/2020 Amir Iqbal IBM BA Updated for CR290, following section/requirements updated

5.4.10.9 Evidences Create/Update Logic

CGIS_SDX_106.2.3

CGIS_SDX_106.3.3

2.8 12/11/2020 Tiffany Ortega IBM BA Lead Updated requirement R2_CGIS_SDX_28.2.2 per

CR314.

2.9 12/15/2020

Vamshi Vankadara

IBM

Developer

CR314 Updates for R2_CGIS_SDX_28.2.2

5.1.16.1 (Service Layer) – Updated method Details performPerfectMatchRecordProcessingPCATS4 0AND57AND71 Added step 3-2-1) To update current PDC Certification.

2.10 12/28/2020 Amir Iqbal IBM BA Update the work queue name in the task 14 based on the email from Abhishek on 12/21/2020

2.11 1/7/21 Amir Iqbal IBM BA Update the req R2_CGIS_SDX_4.8.4.2.3 based on CR318.

V3.0 4/11/2021 Erin Coleman SCDHHS

Process & Artifact Development Manager

Updated version number, watermark, and approval date.

MMRP CGIS Project ADD Page 17 of 477

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

DDI Manager

Product Manager / Business Analyst

3/22/2020

Technical Lead 5/7/2019 (CR23, 1st round FDS)

5/17/2019 (CR23, 2nd round FDS)

5/22/2019 (CR23, 3rd round completed)

Business Analyst

Technical SME

Subject Matter Expert

(SME)

8/1/2019 Renjan Bhasi (CR059)

4/6/2020

Renjan Bhasi (R1-4-R2, cycle 2)

6/25/2020 Renjan Bhasi (R1-4-R2)

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 SME

7/9/2019 Renjan Bhasi (CR023)

7/15/2019 Renjan Bhasi (CR023)

8/1/2019 Renjan Bhasi (CR059)

8/8/2019 Renjan Bhasi (CR59)

MMRP CGIS Project ADD Page 18 of 477

SCDHHS Role First Review Date / Reviewer Name

Second Review Date / Reviewer Name

Third Review Date / Review Name

Technical Lead 4/12/2020 Renjan Bhasi (R1-4-R2)

6/30/2020 Renjan Bhasi (R1-4-R2)

MMRP CGIS Project ADD Page 19 of 477

IBM Approval Review Log

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.

Functional Design Section

IBM Functional Design Approval Review – v3.0

Role Name Date Comments

CGIS Project Manager Courtney Stevens 3/23/2021 Approved v2.11 to v3.0

CGIS Development Lead Vijay Mujumdar 3/23/2021 Approved v2.11 to v3.0

CGIS BA Lead Tiffany Ortega 3/23/2021 Approved v2.11 to v3.0

CGIS Testing Lead Brian Grieves 3/23/2021 Approved v2.11 to v3.0

CGIS Business Analyst Amir Iqbal 3/23/2021 Approved v2.11 to v3.0

CGIS Development Team Lead

Randhir Singh 3/23/2021 Approved v2.11 to v3.0

Technical Design Section

IBM Technical Design Approval Review – v3.0

Role Name Date Comments

CGIS Development Lead Vijay Mujumdar 3/23/2021 Approved v2.11 to v3.0

CGIS Development Team Lead Randhir Singh 3/23/2021 Approved v2.11 to v3.0

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Approval Logs

The Approvals Section captures the Approval of the current Approved Major version (whole number per PMP). The approval tables will be copied to the Approval Appendix when changes are made that require a subsequent round of Approvals.

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.

Functional Design Approval v3.0

Role Name Date Approvals (✓)

SCDHHS DDI Manager Tim Cozine 4/7/2021 Approved V2.9

SCDHHS Product Manager Abhishek Sahu 4/7/2021 Approved V2.9

SCDHHS Technical Lead Renjan Bhasi

SCDHHS Business Analyst Abhishek Sahu 4/7/2021

SCDHHS Process & Artifact Development Manager

Erin Coleman 4/11/2021 ADD Approved

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

Role Name Date Approval (✓)

SCDHHS Technical Lead Renjan Bhasi

SCMMRP CGIS Project ADD Page 21 of 477 CGISS36 SDX Interface – v2.0

Table of Contents

1 Introduction

1.1Background

1.2Purpose

1.3Scope

1.4Key References

1.5Definitions and Acronyms

1.6Key Assumptions

2 Conceptual Flow

2.1Inbound SDX Update Files Processing

2.1.1 Inbound SDX Update Files Processing Narrative

2.2Person Search and Match Processing

2.2.1 Person Search and Match Processing Narrative

2.3SDX Updates File – T30/33 Payment Status Code Processing

2.3.1 SDX Updates File – T30/T33 Payment Status Code Processing Narrative

2.4SDX Updates File – Eligible Code Processing

2.4.1 SDX Updates File – Eligible Code Processing Narrative

2.5SDX Updates File – E01 Code Processing

2.5.1 SDX Updates File – E01 Code Processing Narrative

2.6SDX Eligible Code Processing for R2 PCATs

Following flows and descriptions are for R2 PCATs 10,33,54,85,86

3 Requirements Matrix

3.1Requirement Modifications

4 Functions

4.1Inbound SDX Update Files Processing

4.1.1 Design Description

4.1.2 Functional Output

Table of Contents

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4.1.3 Design Details

4.1.4 Screen Flow – N/A

4.1.5 Screen Mockup – N/A

4.1.6 Business Rules – N/A

4.1.7 User Roles – N/A

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 Validation – N/A

4.1.12 Notifications and Tasks – N/A

4.1.13 Other – N/A

4.2Person Search and Match Process

4.2.1 Design Description

4.2.2 Functional Output

4.2.3 Design Details

4.2.4 Screen Flow – N/A

4.2.5 Screen Mockup – N/A

4.2.6 Business Rules – N/A

4.2.7 User Roles – N/A

4.2.8 Data Fields – N/A

4.2.9 Links – Navigation – N/A

4.2.10 Links – Functions/Actions – N/A

4.2.11 Validation – N/A

4.2.12 Notifications and Tasks

4.2.13 Other – N/A

4.3SDX Updates File - Payment Status Code T30/T33 Processing

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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 Mockup – N/A

4.3.6 Business Rules – N/A

4.3.7 User Roles – N/A

4.3.8 Data Fields – N/A

4.3.9 Links – Navigation -N/A

4.3.10 Links – Functions/Actions – N/A

4.3.11 Validations – N/A

4.3.12 Notifications and Tasks

4.3.13 Other – N/A

4.4SDX Updates File - Transaction Code 03/05 Processing

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 Mockup – N/A

4.4.6 Business Rules – N/A

4.4.7 User Roles – N/A

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

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4.4.13 4.4.13 Other – N/A

4.5SDX Updates File - Transaction Code 0P/OP or Payment Status Code H80 Processing 86

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 Mockup – N/A

4.5.6 Business Rules – N/A

4.5.7 User Roles – N/A

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

4.6SDX Updates File - Eligible code processing

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 Mockup – 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

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4.6.11 Validation – N/A

4.6.12 Notifications and Tasks

4.6.13 Other – N/A

4.7SDX Updates File – Ineligible Code processing

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 Mockup – N/A

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

4.7.13 Other – N/A

4.8SDX Update File – Ex-parte/Reassessment Process

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 Mockup – N/A

4.8.6 Business Rules – N/A

4.8.7 User Roles – N/A

4.8.8 Data Fields – N/A

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4.8.9 Links – Navigation – N/A

4.8.10 Links – Functions/Actions – N/A

4.8.11 Validation – N/A

4.8.12 Notifications and Tasks

4.8.13 Other – N/A

4.9Reconciliation File Processing

4.9.1 Design Description

4.9.2 Functional Output

4.9.3 Design Details

4.9.4 Screen Flow – N/A

4.9.5 Screen Mockup – 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

4.10Cost of Living Adjustments (COLA) Processing

4.10.1 Design Description

4.10.2 Functional Output

4.10.3 Design Details

4.10.4 Screen Flow – N/A

4.10.5 Screen Mockup – N/A

4.10.6 Business Rules – N/A

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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

4.11Treasury File Process

4.11.1 Design Description

4.11.2 Functional Output

4.11.3 Design Details

4.11.4 Screen Flow – N/A

4.11.5 Screen Mockup – N/A

4.11.6 Business Rules – N/A

4.11.7 User Roles – N/A

4.11.8 Data Fields – N/A

4.11.9 Links – Navigation – N/A

4.11.10 Links – Functions/Actions – N/A

4.11.11 Validation – N/A

4.11.12 Notifications and Tasks – N/A

4.11.13 Other – N/A

4.12503 Leads File Process

4.12.1 Design Description

4.12.2 Functional Output

4.12.3 Design Details

4.12.4 Screen Flow – N/A

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4.12.5 Screen Mockup – N/A

4.12.6 Business Rules – N/A

4.12.7 User Roles – N/A

4.12.8 Data Fields – N/A

4.12.9 Links – Navigation – N/A

4.12.10 Links – Functions/Actions – N/A

4.12.11 Validation – N/A

4.12.12 Notifications and Tasks – N/A

4.12.13 Other – N/A

4.13Pass Along/Pickle File Processing

4.13.1 Design Description

4.13.2 Functional Output

4.13.3 Design Details

4.13.4 Screen Flow – N/A

4.13.5 Screen Mockup – N/A

4.13.6 Business Rules – N/A

4.13.7 User Roles – N/A

4.13.8 Data Fields – N/A

4.13.9 Links – Navigation – N/A

4.13.10 Links – Functions/Actions – N/A

4.13.11 Validation – N/A

4.13.12 Notifications and Tasks – N/A

4.13.13 Other – N/A

4.14SDX Reports

4.14.1 Design Description

4.14.2 Functional Output

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4.14.3 Design Details

4.14.4 Screen Flow – N/A

4.14.5 Screen Mockup – N/A

4.14.6 Business Rules – N/A

4.14.7 User Roles – N/A

4.14.8 Data Fields – N/A

4.14.9 Links – Navigation – N/A

4.14.10 Links – Functions/Actions – N/A

4.14.11 Validation – N/A

4.14.12 Notifications and Tasks – N/A

4.14.13 Other – N/A

4.15Displaying SDX Interface Data

4.15.1 Design Description

4.15.2 Functional Output

4.15.3 Design Details

4.15.4 Screen Flow

4.15.5 Screen Mockup

4.15.6 Business Rules – N/A

4.15.7 User Roles – N/A

4.15.8 Data Fields – N/A

4.15.9 Links – Navigation – N/A

4.15.10 Links – Functions/Actions

4.15.11 Validation

4.15.12 Notifications and Tasks – N/A

4.15.13 Other – N/A

4.16Eligibility Worker, Member Management & Work queue Requirements

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4.16.1 Design Description

4.16.2 Functional Output

4.16.3 Design Details

4.16.4 Screen Flow – N/A

4.16.5 Screen Mockup – N/A

4.16.6 Business Rules – N/A

4.16.7 User Roles – N/A

4.16.8 Data Fields – N/A

4.16.9 Links – Navigation – N/A

4.16.10 Links – Functions/Actions – N/A

4.16.11 Validation – N/A

4.16.12 Notifications and Tasks

5 Technical Design

5.1Common Technical Artifacts

5.1.1 Sequence Diagram

5.1.2 Events – N/A

5.1.3 Event Class Details – N/A

5.1.4 Domain Definitions

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 – N/A

5.1.11 Security Details – N/A

5.1.12 Model – N/A

5.1.13 Interfaces – N/A

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5.1.14 Façades – N/A

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 – N/A

5.1.24 Renderers – N/A

5.1.25 Keywords (Hover Values) – N/A

5.1.26 Help Content – N/A

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 – N/A

5.1.33 Task and Work Queues – N/A

5.1.34 Reports – N/A

5.1.35 Unit Testing Scenarios

5.1.36 Curam Unit Testing Scenarios

5.1.37 ESB Unit Testing Scenarios – N/A

5.1.38 Data Retention – N/A

5.1.39 Persistence Requirements – N/A

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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 Curam Batch Component Techincal 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

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

5.1.60 UIM Configuration Changes

5.1.61 Server Interface Details

5.2ESB Development

5.2.1 Outbound – N/A

5.2.2 Inbound

5.2.3 Supporting Details: Record Layout

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5.2.4 ESB Operational Platform

5.3Rules Development – N/A

5.3.1 Rules (Rules Area) – N/A

5.3.2 Table of Values – N/A

5.4Batch Development

5.4.1 Batch Overview (SDX Inbound Batch)

5.4.2 Functional Summary

5.4.3 Batch Specifications

5.4.4 Data Retention – N/A

5.4.5 Batch Classes – N/A

5.4.6 Batch Methods – N/A

5.4.7 Persistence Requirements

5.4.8 Data Validation Checks – N/A

5.4.9 Event Sequence Diagram

5.4.10 Coding Specifications

5.4.11 Table Names

5.4.12 Input Table Names

5.4.13 Output Table Names

5.4.14 Curam Batch Component Technical Design

5.4.15 Batch Classes

5.4.16 Batch Methods

5.4.17 Entity Classes

5.4.18 Entity Methods

5.4.19 System Properties

5.4.20 Code Tables

5.4.21 Overview

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6 Integration Points/Dependencies

7 Use Cases

8 Appendices

8.1.1 Appendix A: Action Item Matrix

8.1.2 Appendix B: Out of Scope Requirements – N/A

8.1.3 Appendix C: Comment/Resolution Log – N/A

8.1.4 Appendix D: Approval History

8.1.5 Appendix E: SDX Record Layout

8.1.6 Appendix F: SDX Work Queue Requirement

8.1.7 Appendix G: SDX Data to Evidence Mapping

8.1.8 Appendix H: SDX Data Field Level Validations

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1 Introduction

1.1 Background

States are required to follow certain guidelines and procedures in the administration of federally funded income and/or health maintenance programs. SDX Interface provides States with the following data of Supplemental Security Income (SSI) claimants and recipients:

• Eligibility

• Payment

• Demographics

State Data Exchange system is maintained by the Social Security Administration (SSA). SSI data is leveraged by States to assist in making eligibility determinations. SSI eligible persons are automatically eligible for Medicaid in the State of South Carolina.

1.2 Purpose

The purpose of this document is to provide the detailed Design aspects for the State Data Exchange interface in Cúram. This document provides details about the processing of following files:

• Daily Updates file

• Reconciliation File

• Treasury File

• COLA File

• 503 Leads File

• Pass Along/Pickle File

The Architectural Description Document is created during the Design Phase of the project and will be leveraged by development, architecture, and quality assurance teams for implementation.

The intended audiences of 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

This document covers the SDX file(s) processing within the Cúram system. Additionally, related checks that are performed by the system, to identify the eligibility of the Person in MEDS.

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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

SDX Interface BRD SharePoint location for Latest BRD

Master Spreadsheet MasterSpreadsheet

SDX Manual 2018 SDX Manual_March2018

1.5 Definitions and Acronyms

Term Meaning

BEC

Buy-In Eligibility Code

BIC

Beneficiary Identification Code

BRD

Business Requirements Document

CGIS

Cúram Global Income Support

COLA

Cost of Living Adjustment

DHHS

Department of Health and Human Services

DOB

Date of Birth

DOD

Date of Death

DSS

Department of Social Services

ESB

Enterprise Service Bus

HCR

Health Care Reform

MCN

Medicare Claim Number

MMIS

Medicaid Management Information System

RIC

Record Identification Code

RRB

Railroad Board Claim Number

SDX

State Data Exchange

SSA

Social Security Administration https://schhs.sharepoint.com/:w:/r/sites/1211207/CGIS%20Business%20Requirements%20and%20Design%20Documents/MMRP%20CGIS%20SDX%20Interface%20BRD.docx?d=wbae877b38b5c4ce9a245e5f7c55a9a1d&csf=1&web=1&e=ibEBah https://schhs.sharepoint.com/:x:/r/sites/1211207/_layouts/15/Doc.aspx?sourcedoc=%7BE31731BA-FD67-4A40-9F57-058F5DA2D9CC%7D&file=MasterSpreadsheet.xlsx&action=default&mobileredirect=true https://schhs.sharepoint.com/:w:/r/sites/1211207/_layouts/15/Doc.aspx?sourcedoc=%7B2E29FF98-6119-4AF8-A27B-89C237004DAD%7D&file=SDX%20Manual_March2018.doc&action=default&mobileredirect=true

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Term Meaning

SSCN

Social Security Claim Number

SSI

Supplemental Security Income

TC

Transaction Code

TED

Transaction Effective Date

1.6 Key Assumptions

This section lists any key assumptions that is required to complete the understanding of the process.

1. This document has also defined processes for the Payment Categories i.e. PCATs (10, 33, 54, 85, 86) which will not be implemented as part of Phase I. The assumption is that some of these design details might change once Phase II designs for Programs are completed.

2. MEDS will continue to process the SDX records that are provided by Cúram i.e. SDX

Records for members receiving eligibility other than PCAT 80.

3. Date of Death updates through SDX interface will need to be revisited as part of Release 2

DHEC implementation. When date of death is reported in Release 1, there will be no system action that will result in the member losing eligibility.

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2 Conceptual Flow

The flows captured within this section provide a high-level overview of the process. Please refer to the Section “Function” for detailed requirements. These process flow represents individual record level processing, if more than one record are received in the SDX file, then Cúram system will perform sequentially.

2.1 Inbound SDX Update Files Processing

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2.1.1 Inbound SDX Update Files Processing Narrative

Task/Process Task

ID

Narration

DSS receives SDX files from

SSA

DSS receives the SDX files from SSA and consolidates the updates.

MEDS receives SDX files DSS SDX files will be received by MEDS through the existing communication channel i.e. Cyberfusion. And then MEDS will place the file in the HLQ and will not process the original file.

ESB Receives SDX File(s) 1 ESB receives the SDX File(s) i.e. from the mainframe HLQ location where MEDS and places the SDX files.

File Validation 2 File format and header validation will be triggered by ESB job.

Manually retry the SDX file pull 3 If the file validation fails, then ESB will retry the pull manually.

If the file still fails, the validation then the following manual actions will be performed:

Report of file validation to be communicated to DSS to ensure that it’s not an issue between DSS and Cúram.

Next step would be to contact SSA via DSS communication.

Store SDX Records in ESB Tables

4 After successful file validation, records from the file will be inserted into the SDX ESB tables.

Record level validations 6 ESB will perform record level validation to verify that records match the Layout outlined as per Appendix H.

Validation Successful 7 At this step, system checks whether record level validation passes.

Generate Exception Report 8 If at the Task ID 7, system determines that record validation failed then, that record will be queued for exception report generation.

System Processing 9 Once the records are successfully validated then it will be sent to Cúram DB for further system processing.

SDX Files disposed securely 5 Once the master data is stored successfully, SDX physical files need to be securely disposed from the system.

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2.2 Person Search and Match Processing

2.2.1 Person Search and Match Processing Narrative

Task/Process Task ID Narration

DSS Consolidates SDX Files 1 DSS receives SDX files from SSA System daily, DSS consolidates and sends it to MEDS

MEDS Receives SDX Files 2 MEDS currently receives SDX files using

Cyberfusion channel.

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Task/Process Task ID Narration

ESB File Processing 3 ESB receives the SDX File(s) and ingest the file content.

SDX Batch – Record Processing

4 Once the SDX data is received at Cúram, SDX Inbound batch job will trigger the processing.

Person Match based on SSN 5 SDX Record processing starts with the Person search and match, using the SSN as primary criteria.

One or more records with SSN match

6 Person search results in one or more records returned. Based on the result count following path will be taken:

Task ID 7 – Person search based on First Name, Last Name, Gender and Date of Birth Task ID 16 – Person search based on Soundex (First Name), Soundex (Last Name), Gender and Date of Birth.

Person search based on First Name, Last Name, Gender and Date of Birth

7 If one or more records are found using SSN, then system will identify the unique match using First Name, Last Name, Gender and Date of Birth

Unique Match (SSN, First Name, Last Name, Gender, DOB)

8 If the conclusive match is found by the system i.e. person with exact SSN, First Name, Last Name, Gender, Date of Birth is found. Based on the result following path will be taken:

Task ID 9 Task ID 18

Person Match – based on SSN, Soundex (First Name), Soundex (Last Name), Gender, DOB

18 If no unique match is found in the system then system will perform Person search based on Soundex (First Name), Soundex (Last Name), Gender and Date of Birth.

Unique Match (Soundex Search)

19 This is the check to identify the unique match from the Soundex search. Based on the result it will take the following path:

a.) Create Prospect b.) Cúram Eligibility Check

Eligible in Cúram (CGIS or

HCR)

9 At this step the system will check whether Person is eligible in Cúram (i.e. in CGIS or HCR Cases). If the person is already eligible in Cúram then the system will proceed for further SDX Processing.

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Task/Process Task ID Narration

Person Match – based on SSN, Soundex (First Name), Soundex (Last Name), Gender, DOB

NOTE: This is the search when NO result is found using SSN Person Search

16 If person search result count using SSN is Zero, then proceed with Secondary Search criteria: Soundex (First Name), Soundex (Last Name), Date of Birth, and Gender.

If the result returned are multiple, then system will proceed with Task 16: Prospect Person Registration.

One or more records with Soundex Match

17 This check will decide whether system will proceed with prospect person registration or go with the MEDS Check.

Create Prospect 20 If the Person Search using Soundex Match returns one or more records, then the system will create Prospect Person and create a pending application for the prospect. This is because without SSN match system cannot find a unique match.

Generate Task 21 When the system registers Prospect Person and submits an application, a task will be generated and assigned to MIM work queue for the caseworkers to manually register prospect person as a person (member/applicant).

MEDS check 10 This is an important step in the Cúram SDX processing, MEDS Check using SSN Only required under the following scenarios:

a.) Task 9 – When the person’s eligibility cannot be determined in Cúram b.) Task 15 – When the system cannot find any match for the SDX record in Cúram.

Following are the possible outcomes from the MEDS Check:

1.) If the person is found in MEDS, and more than 45 days of eligibility is left in MEDS, then the corresponding SDX record will be separated out into SDX File that needs to be sent to MEDS.

2.) If the person is found in MEDS, and there is no eligibility or less than 45 days of eligibility is left in MEDS, then the corresponding record should be processed in Cúram.

3.) If the person is not found in MEDS, then for such records Person Registration will be triggered in Cúram and further SDX Processing will be performed.

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Task/Process Task ID Narration

Match Found in MEDS 11 This step is to check whether a match was found in MEDS for the Person whose record is being processed.

Eligible in MEDS 12 At this step eligibility (Phase I PCATs) of the person is checked, if NO eligibility found then SDX processing will continue in Cúram else further check will be performed as per the Task

ID 14.

More than 45 days of PCAT Eligibility in MEDS

13 If more than 45 days of eligibility is left in MEDS, then the record will be processed in MEDS else the record will be processed in Cúram.

Person Registration 14 If the Person is not found in both the systems i.e. MEDS and Cúram then the person will be registered in Cúram as New Person for SDX processing.

SDX Processing in Cúram 15 Continued from Task ID 9: SDX Record processing in Cúram will continue i.e. either Eligibility Updates or new Income Support Integrated case creation followed by providing Eligibility.

MEDS SDX Split File Generation

22 This task performed in ESB, where the records identified by SDX Cúram Batch process will be used to generate the SDX MEDS Split File.

MEDS SDX Processing 23 SDX Processing will be performed at the

MEDS as usual based on the records from MEDS SDX Split File.

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2.3 SDX Updates File – T30/33 Payment Status Code

Processing

2.3.1 SDX Updates File – T30/T33 Payment Status Code

Processing Narrative

Task/Process Task

ID

Narration

DSS receives SDX files from

SSA

DSS receives the SDX files from SSA and consolidates the updates.

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Task/Process Task

ID

Narration

MEDS receives SDX files DSS SDX files will be received by MEDS through the existing communication channel i.e. Cyberfusion. Then MEDS will place the file in the HLQ and will not process the original file.

ESB File Processing 1 ESB receives the SDX File(s) and ingest the file content.

SDX Batch Record Processing

2 Data elements from the SDX Record will read by the Cúram batch process.

Check Payment Status Code 3 The Cúram system will check Data element(s): Payment

Status Code (1) from the SDX Record will be used to determine the system actions.

T30/T33 Payment Status Code determined.

4 Once the system evaluate that the Payment Status Code is T30/T33, then system will proceed with step 6.

If System evaluate Payment Status Code other than T30/T33, then system will proceed with Task ID 5.

If T30/33 Timer exists, then stop the timer

5. This is the scenario where a replacement record received for the person (i.e. after receiving T30/T33, other PSC code received within 45 days or after 45 days.)

If 45 days T30/T33 timer already started

6 System will check whether a 45 days T30/T33 timer already exists or not. If timer already started the control will go Task 8 else will continue with Task ID 7.

Create System Timer 7 A Timer of 45 days will be created by the system and this will not RESET even if another SDX record with T30/T33 code is received within 45 days.

Don’t extend timer rather continue wait until 45 days.

8 If T30/T33 timer already present, then system won’t extend the timer rather will continue to wait for the response from the client until 45 days.

System Actions 9 System will wait for 45 days before moving to the next steps.

PCAT 80? 9A System determine member currently on PCAT 80 or not

Yes – Follow the flow for R1, Trigger Termination No – Member on 54/86, Create Task for 54/86

Task for PCAT 54 / 86 9A Member on 54 / 86 and 45-days timer expired, task 6 created for the case worker.

Trigger Termination 10 System will proceed with the Ex-parte.

Alternate Flow 11 If the Payment Status Code is not matching with T33/T30

(i.e. Step 4) or if another SDX transaction is received (i.e.

Step 7) then the Alternate Flow will be followed as per the requirement covered in section 4: Function.

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2.4 SDX Updates File – Eligible Code Processing

2.4.1 SDX Updates File – Eligible Code Processing Narrative

Task/Process Task

ID

Narration

DSS receives SDX files from SSA DSS receives the SDX files from SSA and consolidates the updates.

MEDS receives SDX files DSS SDX files will be received by MEDS through the existing communication channel i.e. Cyberfusion, and then MEDS will place the file in the HLQ and will not process the original file.

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Task/Process Task

ID

Narration

ESB File Processing 1 ESB receives the SDX File(s) and ingest the file content.

SDX Record Processing 2 Data elements from the SDX Record will be read by the Cúram batch process.

Check Payment Status Code & Other Eligibility Criteria

3 Following data elements from the SDX Record will be used by Curam batch to determine the system actions: Payment Status Code, Medicaid Eligibility Code, SSI Gross Payable Amount, Monthly Assistance Amount, Multicategory Indicator, Medicaid Test Indicator

Currently Eligible in CGIS 4 Once the eligibility criteria are checked as per incoming SDX transaction i.e. Task ID 3 then system will proceed with next step.

Check Current PCAT 6 Checking current PCAT checks to determine the system action.

System Actions 7 Next step is checking the pre-conditions defined

(see section 4.6 Eligible Code Processing).

Eligibility Updates 8 Based on rules defined PCAT changes will be applied.

Make PCAT80 Eligible 5 If the person has a pending Application in system or is ineligible, then based on the SSI information the system will allocate PCAT 80. If the application is pending and the application date of the current pending application is prior to the SSI Medicaid eligibility date, then eligibility must still be determined for the earlier period.

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2.5 SDX Updates File – E01 Code Processing

2.5.1 SDX Updates File – E01 Code Processing Narrative

Task/Process Task

ID

Narration

DSS receives SDX files from

SSA

DSS receives the SDX files from SSA and consolidates the updates.

MEDS receives SDX files DSS SDX files will be received by MEDS through the existing communication channel i.e. Cyberfusion. And then MEDS will place the file in the HLQ and will not process the original file.

ESB File Processing 1 ESB receives the SDX File(s) and ingest the file content.

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Task/Process Task

ID

Narration

SDX Record Processing 2 Data elements from the SDX Record will read by the Cúram batch process.

Check PSC/MEC 3 In this step system will establish whether E01 code is received in the SDX Record.

Received E01 in the past 4 System will determine whether E01 was received by the

Person record in the previous SDX Transactions. If YES = System will not take any action.

If NO = System will proceed to step 5.

Current Eligible PCAT 55/80 – Decision Step

5 System will check for the current eligible PCAT in the system and compares with PCAT 80/55.

Current Eligible PCAT is NOT 55/80

6 System will leave the PCAT AS IS.

Current Eligible PCAT is 55/80 7 System will proceed with actions for PCAT 80/55.

Eligible for PCAT 80 8 System will end the current PCAT 80 eligibility by month end and establish PCAT32 for 3 months starting next month.

Eligible for PCAT 55 9 System will terminate current PCAT 55 eligibility as end of month before Record Processing Date and establish PCAT32 for 3 months from beginning of the current month.

2.6 SDX Eligible Code Processing for R2 PCATs

Following flows and descriptions are for R2 PCATs 10,33,54,85,86

3.6.1 Member on PCAT 10 or 33 and Eligible Code Received

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Task/Process Task ID Narration

Currently Receiving Benefit on

10 or 33

1.1 Member currently getting benefits on PCAT 10 or 33.

SDX Eligible Code Received 1.2 SDX eligible code received in the incoming SDX file.

Manual Product? 1.3 Determine is member currently getting benefits on a manual product. If manual product go to 1.12 else 1.4.

SSI Exists? 1.4 Determine if Active SSI exists on the case IF yes THEN

1.5 ELSE 1.11

Add SSI Evidence 1.5 Add Benefit Evidence of type SSI, according to the logic defined in R2_CGIS_SDX_4.8

Apply Changes 1.6 Apply changes for the evidences added/updated by batch.

Moved to 54? 1.7

Determine member has eligibility on PCAT 54 in the first of next month (next to batch processing month).

If member moved to 54 THEN no action ELSE 1.8

Gross Mon Income < 50 1.8

Determine Gross Mon Income < 50 IF yes THEN 1.9

ELSE 1.10

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Task/Process Task ID Narration

Create Task 10 1.9 System creates task 10 “Determine Member Eligible for

PCAT 54”.

Process ends

Create Task 11 1.10 Create task 11 “Verify Monthly Income”

Process ends

Update Existing Evidence 1.11…