PO27-149 Federal Revenue Enhancement 004a Attachment G3 Managed Care Interface Flowchart.pdf
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- Solicitation number
- 26-418DCFS-PROCU-B-53611
- Issued by
- Illinois
About this file
This document is a Managed Care Interface Flowchart attachment (G.3) for Request for Proposal PO27-149 issued by the Illinois Department of Children and Family Services (DCFS) in connection with the Federal Revenue Enhancement and Claiming Systems Support Services contract. The flowchart illustrates the complex data exchange workflows between multiple state systems and managed care entities, including interfaces between the DCFS CYCIS and HealthWorks systems, the DHS IES system, HFS (Department of Healthcare and Family Services), Maximus, YouthCare, and the 24-Hour Medicaid Hotline. The document outlines the daily and quarterly data file exchanges, system processing requirements, and communication protocols using secure email and secure FTP transfers. Key processing timelines shown include the initial hotline call assignment to full match turnaround currently averaging 9.8 days (with a projected 14-day standard and maximum of 358 days), a one-day average lag from IES entry to DCFS receipt and CYCIS posting, and a two-day turnaround time for IES data feeds into MMIS.
The flowchart identifies specific data files exchanged between entities, including daily 834 reconciliation files, daily notification files, daily client enrollment broker files, head-of-home files, and recipient eligibility extract files. The document specifies that HFS technical assistance is required for DCFS cases in HFS managed care, with coordination involving DCFS TSU Staff, Healthworks Staff, YouthCare Staff, and Maximus personnel. The diagram indicates a state working day processing schedule with interface reconciliation and monitoring functions managed across multiple system layers. No pricing, set-aside information, incumbent data, or specific funding amounts are detailed in this flowchart document.
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Text version
MA
System
DCFS TSU Staff Enters Eligibility Info Into the
DHS IES System …..
Daily 834 and Monthly Reconciliation 834 Audit files plus additional claims reconciliation files.
Interface Reconciliation and Monitoring
Medicaid Hotline and MA
Match Processing (MA
& CYCIS)
YouthCare and HFS Daily Notification & Maximus Head of
Home File Processing (MA &
CYCIS)
SACWIS and HealthWorks
(Healthworks Monitoring)
Managed Care
Outbound (From DCFS)
24-Hr Medicaid Hotline
(MA System)
CYCIS
SYstem
D
Inbound (to DCFS)
Mainframe “A” System
SACWIS
HEALTH
WORKS
YouthCare Inbound to DCFS
• A – Amisys ID YIC and FYIC Block Upload Spreadsheet
DCFS Outbound to YouthCare
• B – Daily Notification File (DNF File)
DCFS Outbound to Maximus
• C – Daily Client Enrollment Broker (HOH Name) file
DCFS Outbound to HFS
• D – Daily HFS Head-of-Home (DNF Format) File
HFS Inbound to DCFS
• E – Full Copy of Daily Recipient Eligibility (RDE) File
• F – Quarterly Recipient Eligibility (RDE) Extract
DHS Inbound to DCFS
• G- Daily IES Interface File
Initial Hotline Call Assignment Process to Full
Match Turnaround
(Projected 14 days – Current 2022 Avg.: 9.8 days – Max 358 days)
Turnaround Document (Full Match) to IES Entry
(Current Avg.: 1 day)
Lag from IES Entry to DCFS Receipt of Daily Interface File and posting to CYCIS
(1 business day)
B
B E F
Healthworks Staff YouthCare Staff
DCFS TSU Staff Provides HFS with technical assistance for DCFS Cases in HFS Managed Care
SECURE
SECURE
FTP
SECURE
FTP
Department of Children and Family Services Request for Proposal
Federal Revenue Enhancement and Claiming Systems Support Services
PO27-149
26-418DCFS-PROCU-B-53611
Attachment G.3.
Managed Care Interface Flow Chart
14 days 15 days 16 days
G
State Working Day Processing Schedule
Maximus Client Enrollment Broker Files
C
IES Data feeds into MMIS (2 Day Turnaround Time)
This is the FTP Path desired by
HFS – FTP
directly to Maximus from
DCFS.
18 days
File details come from the government source that posted it. Updated .