Table : Operations Management Detailed Results Kentucky MITA Action to Meet MITA To Be Business Process Condition/Standard Capability Gap and 7C&S OM02 Authorize Service Manual processes are Business Results Condition Implement automation to be used by the more effective and efficient Commonwealth for authorization for FFS claims needing preapproval or post approval OM02 Authorize Service The Authorize Service Modularity Standard Implement a separate Rules request may take Engine to automate processes many days. Accessing the data required to make the decision may take days. OM02 Authorize Service Authorization of Interoperability Condition Improve the exchange of data by service is automating the approval/denial communicated to notifications. other health care agencies and participants OM03 Authorize Treatment Authorize Treatment Modularity Standard Implement a separate Rules Plan Plan requests are Engine to automate processes manually validated against state specific business rules.
Table : Operations Management Detailed Results Business Process Kentucky MITA Capability Gap Condition/Standard Action to Meet MITA To Be and 7C&S OM02 Authorize Service Manual processes are used by the Commonwealth for authorization for FFS claims needing preapproval or post approval Business Results Condition Implement automation to be more effective and efficient OM02 Authorize Service The Authorize Service request may take many days. Accessing the data required to make the decision may take days. Modularity Standard Implement a separate Rules Engine to automate processes OM02 Authorize Service Authorization of service is communicated to other health care agencies and participants Interoperability Condition Improve the exchange of data by automating the approval/denial notifications. OM03 Authorize Treatment Plan Authorize Treatment Plan requests are manually validated against state specific business rules. Modularity Standard Implement a separate Rules Engine to automate processes