PM02 Disenroll Provider Disenrollments may Business Results Condition KYHealth Choices and DFWAIP be caused by a variety may be involved in the process of of reasons, including disenrollment; Implement a loss of license, formal monitoring process to retirement, or desire to ensure adherence to MITA no longer participate standards and interfaces PM02 Disenroll Provider Results of Interoperability Condition Modify interfaces with MCOs and disenrollment activities other related agencies to utilize are communicated to open architecture (SOA, MCOs, providers, and Enterprise Service Bus, MITA other related agencies standard interface formats) PM03 Inquire Provider Information requests Business Results Condition Use more online request Information are received from a processing (with variety of sources; verification/validation performed most are responded to against a user-controlled rules by phone, FAX or engine) and electronic/automated USPS methods to distributing the information PM04 Manage Provider Information requests Business Results Condition Implement automation to improve Communication are received from a consistency in reporting and variety of sources tracking PM04 Manage Provider Completed Reporting Condition Expand Decision Support Communication communications, after database to store completed research and creation, communications in order to allow are distributed inquiry and reuse easily PM05 Manage Provider Transitions are Business Results Condition Implement automation to improve Grievance and Appeal received in various consistency in reporting and manners, including tracking inbound transactions; steps are primarily manual
PM02 Disenroll Provider Disenrollments may be caused by a variety of reasons, including loss of license, retirement, or desire to no longer participate Business Results Condition KYHealth Choices and DFWAIP may be involved in the process of disenrollment; Implement a formal monitoring process to ensure adherence to MITA standards and interfaces PM02 Disenroll Provider Results of disenrollment activities are communicated to MCOs, providers, and other related agencies Interoperability Condition Modify interfaces with MCOs and other related agencies to utilize open architecture (SOA, Enterprise Service Bus, MITA standard interface formats) PM03 Inquire Provider Information Information requests are received from a variety of sources; most are responded to by phone, FAX or USPS Business Results Condition Use more online request processing (with verification/validation performed against a user-controlled rules engine) and electronic/automated methods to distributing the information PM04 Manage Provider Communication Information requests are received from a variety of sources Business Results Condition Implement automation to improve consistency in reporting and tracking PM04 Manage Provider Communication Completed communications, after research and creation, are distributed Reporting Condition Expand Decision Support database to store completed communications in order to allow inquiry and reuse easily PM05 Manage Provider Grievance and Appeal Transitions are received in various manners, including inbound transactions; steps are primarily manual Business Results Condition Implement automation to improve consistency in reporting and tracking