OM15 Prepare 1 The process is automated but there is manual intervention in Capitation Premium places. Payment State specific business rules have been automated for most situations. Payment calculations are performed nightly during batch processing. Accuracy and consistency is performed at a fairly high level due to the level of automation. satisfaction is fairly high. Stakeholders’ OM16 Prepare 1 The Prepare Health Insurance Premium Payment process is a Health Insurance manual process. Premium Payment The process requires at least 30 days to complete. Access to the data is very limited. The cost effectiveness of the process is low due to the lack of automation. satisfaction is very low and there are many Stakeholders’ issues associated with the process. 2 OM17 Prepare There is a mix of both automated and manual processes. Medicare Premium DMS exchanges information with SSA via electronic interfaces Payment based on HIPAA standards. The process requires fewer than 10 days to complete. satisfaction is fairly high. Stakeholders’ OM18 Inquire 2 Requests are received by the Fiscal Agent (FA) through paper, Payment Status phone, fax, email, AVRS, and web portal. Current process is a mix of automated and manual steps. Support X12 276/277 transactions Stakeholder satisfaction is good. OM19 Manage 2 The Manage Payment Information business process is meeting Payment the needs of managed care and waiver programs. Information Payment history updates continues to be scheduled around MMIS production cycles Data sources are primarily electronic. Stakeholder satisfaction is good.
OM15 Prepare Capitation Premium Payment 1 The process is automated but there is manual intervention in places. State specific business rules have been automated for most situations. Payment calculations are performed nightly during batch processing. Accuracy and consistency is performed at a fairly high level due to the level of automation. Stakeholders’ satisfaction is fairly high. OM16 Prepare Health Insurance Premium Payment 1 The Prepare Health Insurance Premium Payment process is a manual process. The process requires at least 30 days to complete. Access to the data is very limited. The cost effectiveness of the process is low due to the lack of automation. Stakeholders’ satisfaction is very low and there are many issues associated with the process. OM17 Prepare Medicare Premium Payment 2 There is a mix of both automated and manual processes. DMS exchanges information with SSA via electronic interfaces based on HIPAA standards. The process requires fewer than 10 days to complete. Stakeholders’ satisfaction is fairly high. OM18 Inquire Payment Status 2 Requests are received by the Fiscal Agent (FA) through paper, phone, fax, email, AVRS, and web portal. Current process is a mix of automated and manual steps. Support X12 276/277 transactions Stakeholder satisfaction is good. OM19 Manage Payment Information 2 The Manage Payment Information business process is meeting the needs of managed care and waiver programs. Payment history updates continues to be scheduled around MMIS production cycles Data sources are primarily electronic. Stakeholder satisfaction is good.