selection/assignment will occur there. There will be real-time transaction processing between KHBE and KYMMIS. KYMMIS processes will assign the Preferred Medical Plan (PMP). 834s will still be a batch process. Member linking will be done in the KHBE, not in the KYMMIS. KHBE will generate the rate cell and hand off to the KYMMIS so the calculation will not be performed a second time in the KYMMIS. All changes to member demographics will be done through the worker portal in the KHBE which will feed the downstream ancillary systems. AS-IS TO-BE Note(s) Manage Capitation Payment Assessment Assessment Capability Question Is the process primarily manual or automatic? 3 4 Constraint: Does the State Medicaid Agency use standards in 2 2 Planned the process? enhancements will not advance maturity level to next level (eligibility system). Constraint: What methodology does SMA use to prepare the 2 2 Planned Capitation Premium payments? enhancements will not advance maturity level to next level (eligibility system). Constraint: How does the State Medicaid Agency collaborate 2 2 Planned with other agencies or entities in performing the enhancements will process? not advance maturity level to next level (eligibility system). How timely is this end-to-end process? 2 3 How accurate is the information in the process? 2 3 How accessible is the information in the process? 2 3 What is the cost to perform the process compared 2 3 to the benefits of the results? How efficient is the process? 2 3 Constraint: How accurate are the results of the process? 3 3 Planned enhancements will not advance maturity level to next level (eligibility system). Does the business process satisfy stakeholders? 2 3 Business Process Assessment 2 2 Table 52: Manage Capitation Payment Business Process 2.2.5.12 Manage Incentive Payment The Manage Incentive Payment business process accommodates administration of various incentive compensations to payers, providers, and members. Federal or state policy defines the programs, which are typically short duration and limited in scope. The policy defines specific periods, qualification
selection/assignment will occur there. There will be real-time transaction processing between KHBE and KYMMIS. KYMMIS processes will assign the Preferred Medical Plan (PMP). 834s will still be a batch process. Member linking will be done in the KHBE, not in the KYMMIS. KHBE will generate the rate cell and hand off to the KYMMIS so the calculation will not be performed a second time in the KYMMIS. All changes to member demographics will be done through the worker portal in the KHBE which will feed the downstream ancillary systems. Manage Capitation Payment AS-IS Assessment TO-BE Assessment Note(s) Capability Question Is the process primarily manual or automatic? 3 4 Does the State Medicaid Agency use standards in the process? 2 2 Constraint: Planned enhancements will not advance maturity level to next level (eligibility system). What methodology does SMA use to prepare the Capitation Premium payments? 2 2 Constraint: Planned enhancements will not advance maturity level to next level (eligibility system). How does the State Medicaid Agency collaborate with other agencies or entities in performing the process? 2 2 Constraint: Planned enhancements will not advance maturity level to next level (eligibility system). How timely is this end-to-end process? 2 3 How accurate is the information in the process? 2 3 How accessible is the information in the process? 2 3 What is the cost to perform the process compared to the benefits of the results? 2 3 How efficient is the process? 2 3 How accurate are the results of the process? 3 3 Constraint: Planned enhancements will not advance maturity level to next level (eligibility system). Does the business process satisfy stakeholders? 2 3 Business Process Assessment 2 2 Table 52: Manage Capitation Payment Business Process 2.2.5.12 Manage Incentive Payment The Manage Incentive Payment business process accommodates administration of various incentive compensations to payers, providers, and members. Federal or state policy defines the programs, which are typically short duration and limited in scope. The policy defines specific periods, qualification