Different Ways to Extend CAREWare Functionality
Extending CAREWare functionality has been a movement for Arizona based Ryan White Grant Recipients for purposes of system based eligibility calculations, grant management, grant oversight on services reported, AIDS Drug Assistance Program (ADAP) management of insurance premium payments and health insurance premium and cost sharing payments.
In 2008, this process was developed using a series of updaters that run nightly on the CAREWare database. The updaters verify and calculate values in custom fields of CAREWare. In 2012, the process was enhanced by adding web based applications to streamline process flows within the provider agencies. We wanted to highlight some ways we have extended the functionality of CAREWare.
ADAP Based Functionality
The extended functionality used in the Arizona ADAP has streamlined Application/Renewal Referral Processing and tracking insurance premium payments and HIPSCA payments. The extended functionality also allows for the sharing of the application and eligibility status.
One of the first apps we created for the pharmacy was for the ADAP 340B Pharmacy. This is a .net based interface that allows the external private Pharmacy to view consumer eligibility, ADAP Eligibility, demographic and medical information. It provides one simple view of the consumer record versus running the full CAREWare application.
With the implementation of the Affordable Care Act in 2010, we needed a method to track insurance payments for eligible ADAP consumers that the Medical Benefits Manager could access. The solution was the ADAP Insurance MBM app. This is a .net based interface which allows the Insurance MBM to manage monthly scheduled premium payments and medical copay payments. The app also provides an analysis of a payment request against the consumer’s eligibility. It also generates the appropriate services posted to CAREWare and financial reports.
To streamline the ADAP application/renewal process, the ADAP Application/Renewal Referral Processing App was developed. This is a .net based interface to allow for the ADAP application processing team a simple interface for tracking the processing of an ADAP application/renewal. It also provides a messaging interface to the providers on the status of a referral. The messages indicate that the referral has been updated, completed, rejected, allowing CAREWare to provide an indicator that something has changed. The app also provides a simplified one-page interface from the completed referral to complete the data entry requirements for the consumer demographics, ADAP custom data fields, Annual Review Data elements (Income and Insurance Assessments) and the ADAP status fields. It provides a quality check on the data entered, for completeness, for accuracy. It also provides a mechanism to run the eligibility update on the current consumer versus waiting 24 hours to see the status.
We needed an interface that allowed requests to be sent for Health Insurance Premium and Cost Sharing Assistance (HIPSCA) based payments. This led to the development of the HIPCSA app. This is a .net based interface to allow for the designated provider or could be across many providers to requests for HIPCSA based payments to be made on behalf of a consumer. It also provides an analysis of a payment request against the consumer’s eligibility. Another feature is it generates the appropriate services posted to CAREWare and finance reports.
General Part A and Part B Functionality
The CAREWare functionality was also extended for both the Arizona Part A and Part B programs. We wanted to streamline the eligibility process, help determine if consumers are eligible for services received and provide contracted providers with a simple interface to view their consumer’s information.
The app created for Eligibility allows the case managers/eligibility staff to receive, review and post the corresponding data collected from a renewal to CAREWare. Every night, the system runs a series of data quality checks (for required information), calculates the upcoming renewal date and type of renewal.
The renewals are aligned with the consumer’s birthday and half birthday. The Eligibility Custom fields are used to indicate the most recent status of Eligibility. The Attachment Custom Fields store the actual documents provided at enrollment/renewal for all providers that serve the consumer to see.
The Service Analysis was developed verify a consumer was eligible for services posted to CAREWare. This is an overnight system process that analyzes services posted for a consumer against the Eligibility status determined. It verifies that the eligibility did not expire before the service was performed, that FPL Income level meets the currently funded levels, and it ties to a Grant Management System tool that tracks the contractor’s payments for detailed financial reporting and budgeting.
Contracted providers requested a simple view of consumer eligibility and demographic information. This led to the development of RWPB / RWPA Provider Network. This is a .net based interface to allow for the contracted providers a simple interface to view consumer eligibility, ADAP eligibility, demographic and medical information. It also provides the ability to view and create referrals. This extended view includes referrals from other providers and referrals that have been completed (within CAREWare these are not always visible). It also allows providers to view the list of HIPCSA payments made on behalf of the from any provider and view the premium payments made from the ADAP program for the consumer’s insurance. For Arizona, we also included the ADAP Half Birthday Confirmation Form for having the consumer verify the current address, phone, insurance, and income reported for signature.
There are many ways to extend CAREWare Functionality. They can be used for quality control as well as for grant oversight. By extending CAREWare functionality, we experienced benefits in the following areas:
- Grant Management - Oversight on services reported, data quality check, track payments for detailed financial reporting and budgets.
- ADAP Management : Application/Renewal Referral Processing, easily track insurance premium payments and HIPSCA payments, shared application and eligibility status.
- Quality Control : System based updaters to verify and calculate values in the custom fields of CAREWare.
- Web-Based Applications : Streamline process flows within the provider agencies, messaging interfaces to provider, custom user-friendly interface, custom data fields and color coding.
- Meeting Mandatory Reporting Requirements : RSR, ADR, Continuum of Care Cascades, etc.
The major benefit we discovered was the time savings. By creating this extended functionality with updaters that run nightly. We found that staff spent less time performing administrative tasks therefore giving them more time with consumers.