Care Authorization CM09 Authorize No standard KPI for MCOs 1 2 Management Determination Treatment Plan No central rules engine (CM) Mix of state specific standards Mostly manual process No use of HIE data for clinical decision making Contractor Contractor CO01 Manage 2 3 Limited workflow tools Management Information Contractor Information Process is mostly manual (CO) Management No business rules engine No KPI Contractor Contractor CO04 Inquire 1 1 No gap Management Information Contractor Information (CO) Management Contractor Contractor CO02 Manage 1 2 Limited use of web based technologies and alerts Management Support Contractor No formal communications management plan (CO) Communication Limited formalization of overall process Limited use of automated workflow Communications are available only in English No KPI Contractor Contractor CO03 Perform 1 2 Limited use of web based technologies and alerts Management Support Contractor Outreach No formal communications management plan (CO) Limited formalization of overall process Limited use of automated workflow Communications are available only in English No KPI Contractor Contractor CO09 Manage 1 2 No workflow tools Management Support Contractor Grievance & Standards needed for data exchange and interface (CO) Appeal Limited use of web based technologies
Care Management (CM) Authorization Determination CM09 Authorize Treatment Plan 1 2 No standard KPI for MCOs No central rules engine Mix of state specific standards Mostly manual process No use of HIE data for clinical decision making Contractor Management (CO) Contractor Information Management CO01 Manage Contractor Information 2 3 Limited workflow tools Process is mostly manual No business rules engine No KPI Contractor Management (CO) Contractor Information Management CO04 Inquire Contractor Information 1 1 No gap Contractor Management (CO) Contractor Support CO02 Manage Contractor Communication 1 2 Limited use of web based technologies and alerts No formal communications management plan Limited formalization of overall process Limited use of automated workflow Communications are available only in English No KPI Contractor Management (CO) Contractor Support CO03 Perform Contractor Outreach 1 2 Limited use of web based technologies and alerts No formal communications management plan Limited formalization of overall process Limited use of automated workflow Communications are available only in English No KPI Contractor Management (CO) Contractor Support CO09 Manage Contractor Grievance & Appeal 1 2 No workflow tools Standards needed for data exchange and interface Limited use of web based technologies