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Non-Coop and OHCA

CSS has an OHCA liaison who communicates between OHCA and CSS on cases that have issues with the coop code.  Just telling OHCA a person is in Cooperation status with CSS is not enough.  The OHCA system will not allow approval of benefits for a person if they are receiving a non-coop code from CSS.

The data file between OHCA and CSS runs every night and is the only data share between our systems.

When CSS sends the non-coop code on an OHCA case, OHCA is required to give the OHCA applicant an additional 12 days of coverage.  For example: if OHCA got the non-coop update (aka BU or batch update) file this morning 12/28/17, OHCA would reprocess the same day and remove them from benefits effective 1/9/18.  OHCA then sends a system-generated case status letter informing the member that they will be removed from OHCA benefits effective 1/9/18 due to CSS non-coop.

To help alleviate some problems, CSS has requested OHCA share with all of their reps that there is no special code or a so-called DET number that CSS can enter to make an immediate update to their OHCA case.

Things for CSS to Remember:

  • If a CP calls about being in non-coop on an OHCA case, check to see if they have additional FGNs that may be coded as non-coop.  You can do this by entering CSCP on the NEXT: line on CSML.  You can easily see if a case is coded ‘N’ or ‘O’ cooperation status on all cases that CP is tied as a CP.
  • If a child has a REMOVED date and RSN on the CHU screen, none of the coop/non-coop updates will be sent over to OHCA.  You have to zero out the date and space through the RSN.  Make sure to check all children on the case.
  • The OHCA case must be cross-referenced to the FGN.  Check CSRL for all of the assistance cases cross-referenced to the FGN.
  • CCPU must be cross-referenced to the OHCA case with the active IND ID number for the CP.  Sometimes a person may be listed on the HCAL screen multiple times.  You want to use the IND ID number for that person who does not have a REMOVE DT on HCAL.
  • CHU screen must be cross-referenced to the OHCA case with the active (non-removed) IND ID number for that child.
  • If a child is listed in the household on the OHCA case, but is not receiving any OHCA benefits, additional actions may be needed on OHCA’s side.  You can email those problems to the OHCA Liaison and they will email OHCA.  Please include the OHCA case number, FGN, CP name, and Child not receiving OHCA benefits (but is in the household).
  • Any updates you make to a FGN will take at least 1 overnight to show on OHCA’s side.
  • Last but not least, remember to update DOCL with ‘V’ (Received) when required documents are returned by the CP, and check CCPU to make sure it reflects CP’s coop status when those documents are returned.  This will help to prevent CP’s from being put in non-coop automatically when they are cooperating.