ME03 Disenroll Member Process requires the Interoperability Condition Automate the disenrollment of interaction of systems members based on State for various business rules or Federal stakeholders. regulations. Members should Workers in remote also be automatically disenrolled offices use KAMES to from Waiver and Managed Care process application programs if program rules require data. it. ME04 Inquire Member Requests are received Modularity Standard Implement standard SOA based Eligibility in various formats, services to make the process primarily electronic modular and standardized across transactions the enterprise. ME04 Inquire Member Process is a Interoperability Condition Convert the process to exposed Eligibility combination of several services using open interfaces inquiry technologies and systems. Automated inquiries currently use HIPAA transactions and AVRS functionality. ME05 Manage Applicant and Requests are received Modularity Standard Implement electronic Member in various formats, communication methods to Communication primarily electronic merge inquiries into a single transactions stream and maintain electronic copies of communications. ME05 Manage Applicant and Most inquiries are Business Results Condition Implement automated tools for Member researched manually, workflow management to Communication leading to inconsistent streamline response process. results and efficiency
ME03 Disenroll Member Process requires the interaction of systems for various stakeholders. Workers in remote offices use KAMES to process application data. Interoperability Condition Automate the disenrollment of members based on State business rules or Federal regulations. Members should also be automatically disenrolled from Waiver and Managed Care programs if program rules require it. ME04 Inquire Member Eligibility Requests are received in various formats, primarily electronic transactions Modularity Standard Implement standard SOA based services to make the process modular and standardized across the enterprise. ME04 Inquire Member Eligibility Process is a combination of several inquiry technologies and systems. Automated inquiries currently use HIPAA transactions and AVRS functionality. Interoperability Condition Convert the process to exposed services using open interfaces ME05 Manage Applicant and Member Communication Requests are received in various formats, primarily electronic transactions Modularity Standard Implement electronic communication methods to merge inquiries into a single stream and maintain electronic copies of communications. ME05 Manage Applicant and Member Communication Most inquiries are researched manually, leading to inconsistent results and efficiency Business Results Condition Implement automated tools for workflow management to streamline response process.