Table : Provider Management Detailed Results Kentucky MITA Action to Meet MITA To Be Business Process Condition/Standard Capability Gap and 7C&S PM01 Enroll Provider Automated processes Modularity Standard Implement separate rules engine within this business to verify/validate submitted process include the information and subsequent handling of provider communications application, application changes, and verification of data PM01 Enroll Provider Provider enrollment is Industry Standard Condition Implement MITA standards and monitored by outside interfaces to improve efficiency organizations and consistency PM01 Enroll Provider MCOs perform a major Business Results Condition Implement a formal monitoring portion of the process to ensure adherence to enrollment process; MITA standards and interfaces finalization of enrollment is done by State PM01 Enroll Provider Competition of the Interoperability Condition Modify interfaces with MCOs and enrollment process other related agencies to utilize involves open architecture (SOA, communication with Enterprise Service Bus, MITA credentialers, the standard interface formats) provider, MCOs, and other State agencies PM02 Disenroll Provider Both voluntary and Modularity Standard Implement separate rules engine involuntary to verify/validate submitted disenrollments are information and associated processed provider communications PM02 Disenroll Provider Provider disenrollment Industry Standard Condition Implement MITA standards and is monitored by interfaces to improve efficiency outside organizations and consistency
Table : Provider Management Detailed Results Business Process Kentucky MITA Capability Gap Condition/Standard Action to Meet MITA To Be and 7C&S PM01 Enroll Provider Automated processes within this business process include the handling of application, application changes, and verification of data Modularity Standard Implement separate rules engine to verify/validate submitted information and subsequent provider communications PM01 Enroll Provider Provider enrollment is monitored by outside organizations Industry Standard Condition Implement MITA standards and interfaces to improve efficiency and consistency PM01 Enroll Provider MCOs perform a major portion of the enrollment process; finalization of enrollment is done by State Business Results Condition Implement a formal monitoring process to ensure adherence to MITA standards and interfaces PM01 Enroll Provider Competition of the enrollment process involves communication with credentialers, the provider, MCOs, and other State agencies Interoperability Condition Modify interfaces with MCOs and other related agencies to utilize open architecture (SOA, Enterprise Service Bus, MITA standard interface formats) PM02 Disenroll Provider Both voluntary and involuntary disenrollments are processed Modularity Standard Implement separate rules engine to verify/validate submitted information and associated provider communications PM02 Disenroll Provider Provider disenrollment is monitored by outside organizations Industry Standard Condition Implement MITA standards and interfaces to improve efficiency and consistency