OM19 Manage Payment Provides data to other Reporting Condition Accurate data should be Information business processes maintained and exposed to authorized processes within the organization OM20 Calculate Spend Down System manages Modularity Standard Rules engine should be separate Amount spend down rules OM21 Prepare Member Premium amounts are Modularity Standard Implement a separate rules Premium Invoice calculated based upon engine a variety of factors OM21 Prepare Member Calculation process is Business Results Condition Automate the calculation Premium Invoice manual and relies of process, possibly integrate with data external to MMIS the HBE OM21 Prepare Member Invoices are created Reporting Condition Make invoice information Premium Invoice manually available to other systems OM22 Manage Drug Rebate System calculates Modularity Standard Separate the business rules from amounts for rebate for the hard-coded system each manufacturer using internal rules OM23 Manage Estate Process uses Business Results Condition Standardize the data and Recovery data and communication avenues to make communication the process more efficient avenues OM24 Manage Recoupment Process uses Industry Standard Condition Implement the use of standard data and data and communication communication avenues avenues OM26 Manage Recovery Process uses Industry Standard Condition Use standardized data for data data and exchange and reduce communication administrative burden avenues
OM19 Manage Payment Information Provides data to other business processes Reporting Condition Accurate data should be maintained and exposed to authorized processes within the organization OM20 Calculate Spend Down Amount System manages spend down rules Modularity Standard Rules engine should be separate OM21 Prepare Member Premium Invoice Premium amounts are calculated based upon a variety of factors Modularity Standard Implement a separate rules engine OM21 Prepare Member Premium Invoice Calculation process is manual and relies of data external to MMIS Business Results Condition Automate the calculation process, possibly integrate with the HBE OM21 Prepare Member Premium Invoice Invoices are created manually Reporting Condition Make invoice information available to other systems OM22 Manage Drug Rebate System calculates amounts for rebate for each manufacturer using internal rules Modularity Standard Separate the business rules from the hard-coded system OM23 Manage Estate Recovery Process uses data and communication avenues Business Results Condition Standardize the data and communication avenues to make the process more efficient OM24 Manage Recoupment Process uses data and communication avenues Industry Standard Condition Implement the use of standard data and communication avenues OM26 Manage Recovery Process uses data and communication avenues Industry Standard Condition Use standardized data for data exchange and reduce administrative burden