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OMR: HCSIS/CIS Reconciliation - 1/29/2007

Background:
DPW’s Client Information System (CIS) is the record system for Medicaid and non-Medicaid eligibility (base-funded individuals).
PROMISe™ relies on data from CIS for eligibility verification during claims processing.
Eligibility information in HCSIS and CIS must match, or provider claims will be denied.

Reconciliation Process:
The HCSIS/CIS Eligibility Reconciliation process keeps eligibility information between HCSIS and CIS synchronized. On a monthly basis, counties are able to run eligibility exception reports showing mismatches between eligibility information listed in HCSIS and CIS by accessing the Data Warehouse (DW). The reports may be run by accessing the following path: HCSIS > CIS/HCSIS Eligibility Exceptions > OMR & County Programs > Reports. Counties are responsible for eligibility clean-up and are expected to request the DW Eligibility reports to resolve mismatches between CIS and HCSIS with the County Assistance Office (CAO).

The five available exception reports are:

Report Name: Enrolled in an OMR Waiver in HCSIS but Supporting Information is not in CIS
Description: Shows individuals for whom enrollment documentation has been submitted to or prepared by the County and a record has been created in HCSIS but CIS does not have a current or active record of the individual.

Report Name: Enrolled in an OMR Waiver in HCSIS but in a different Waiver in CIS
Description: Shows individuals who have had documentation submitted to or prepared by the County and CAO but for a different waiver.

Report Name: Enrolled in an OMR Waiver in CIS but Supporting Information is not in HCSIS
Description: Shows individuals who appear in CIS as enrolled in an OMR waiver but HCSIS has no record of the individuals.

Report Name: Enrolled in an OMR Waiver in CIS but No Current Waiver Present in HCSIS
Description: Shows individuals who have a record in CIS and HCSIS, however, they are not enrolled in a waiver in HCSIS.

Report Name: OMR Waiver Eligibility Date Mismatch between HCSIS and CIS (post-PROMISeTM)
Description: Shows information on individuals with enrollment dates in CIS that are different than (later than) enrollment dates in HCSIS.

For more detailed information about these reports, access the LMS and download the HCSIS/CIS Eligibility Reconciliation for Wave 3 Counties FM Rollout communication document.

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