Operations Management (OM) Payment and Reporting OM14 Generate Remittance Advice Fiscal Management Fiscal Management Provider Community Alternatives OM18 Inquire Payment Status Management OATS OM27 Prepare Provider Payment CHFS Security Officer OM28 Manage Data Claims Adjudication OM07 Process Claims No Change FA OATS OM29 Process Encounters Community Alternatives OM20 Calculate Spend-Down Amount OM04 Submit Electronic Attachment OM05 Apply Mass Adjustment Performance Management (PE) Compliance Management PE01 Identify Utilization Anomalies No Change RAC Program Integrity PE02 Establish Compliance Incident Program Quality and PE03 Manage Compliance Incident Information Outcomes PE04 Determine Adverse Action Incident FA PE05 Prepare REOMB OATS Plan Management (PL) Plan Administration PL01 Develop Agency Goals and Objectives No Change Commissioner’s Office Fiscal Management PL02 Maintain Program Policy Policy and Operations PL03 Maintain State Plan Community Alternatives Health Plan Administration PL04 Manage Health Plan Information No Change Commissioner’s Office Fiscal Management PL05 Manage Performance Measures Policy and Operations Program Quality and Outcomes Health Benefits Administration PL06 Manage Health Benefit Information No Change Commissioner’s Office Fiscal Management PL07 Manage Reference Information Policy and Operations PL08 Manage Rate Setting Program Quality and Outcomes Provider Management (PM) Provider Information Management
Operations Management (OM) Payment and Reporting OM14 Generate Remittance Advice Fiscal Management Community Alternatives OATS CHFS Security Officer Fiscal Management Provider Management OM18 Inquire Payment Status OM27 Prepare Provider Payment OM28 Manage Data Claims Adjudication OM07 Process Claims FA OATS Community Alternatives No Change OM29 Process Encounters OM20 Calculate Spend-Down Amount OM04 Submit Electronic Attachment OM05 Apply Mass Adjustment Performance Management (PE) Compliance Management PE01 Identify Utilization Anomalies RAC Program Integrity Program Quality and Outcomes FA OATS No Change PE02 Establish Compliance Incident PE03 Manage Compliance Incident Information PE04 Determine Adverse Action Incident PE05 Prepare REOMB Plan Management (PL) Plan Administration PL01 Develop Agency Goals and Objectives Commissioner’s Office Fiscal Management Policy and Operations Community Alternatives No Change PL02 Maintain Program Policy PL03 Maintain State Plan Health Plan Administration PL04 Manage Health Plan Information Commissioner’s Office Fiscal Management Policy and Operations Program Quality and Outcomes No Change PL05 Manage Performance Measures Health Benefits Administration PL06 Manage Health Benefit Information Commissioner’s Office Fiscal Management Policy and Operations Program Quality and Outcomes No Change PL07 Manage Reference Information PL08 Manage Rate Setting Provider Management (PM) Provider Information Management