Download 2015-06-05 KEES Implementation Instructions

A. No Touch Workflow
Almost all medical applications processed in KEES begin by going through the No-Touch
Workflow. Applications that are excluded include non-MAGI paper applications and phone
requests for persons being added to open cases. ‘No Touch’ includes completion of the
following processes:
a. File Clearance – Determine if a person listed on the application is already known to
KEES and, if so, select the existing person. If not, a new person is added to KEES.
b. Registration – Associate the application to a case number, determine for which
individuals coverage is requested and what type of coverage is requested, and
determine the program(s) under which the application can be processed, and record the
program and applicant specific information into KEES.
c. Assignment - assignment of a program to a Worker ID which indicates the office
location.
d. Data Import – the automatic acceptance of information on the application into KEES in
certain instances and the manual acceptance or rejection of information in other
instances.
e. Interfaces – interfaces are called to verify information reported on the application.
f. EDBC – Eligibility Determination and Benefit Calculation uses an OPA rules engine to
determine if the application can be approved or needs to ‘fall out’.
Any application where one or more persons are identified as possibly being an existing
person in KEES will ‘fall out’ of file clearance. In addition, any application where all
persons are determined to be new people who need added to KEES can fall out during
registration if the first person listed on the application is a child. If an application ‘falls out’
of No Touch during File Clearance or Registration, the task is routed to the Clearinghouse
to complete these steps (plus assignment) manually using the same pre-defined criteria
used by the No Touch process. The only exception is applications where a KDHE
Outstationed Worker (OSW) is involved which is routed to KDHE OSW office location.
If the application passes file clearance and a case is successfully created, but the
assignment logic fails, the task is also routed to the Clearinghouse to determine the office
location to which the program is assigned and assign the correct Worker ID.
If an application is successfully file cleared, registered, and assigned, but ‘falls out’ in Data
Import or Verification, the task is routed to the Worker ID assigned to the program. This
could be to the Clearinghouse or DCF.
If an application ‘falls out’ at EDBC, logic determines whether the task is routed to the office
location indicated on the Worker ID or whether it is routed to DCF.
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