Management - Case Identification and Creation IV.N.6.b Operations Phase - Business Architecture Must receive, record and funnel all Overview - Case initial cases into a queue for Management - Case assessment, assignment and Identification and Creation investigation. IV.N.6.b Operations Phase - Must assign caseload to “weights” Business Architecture cases (e.g., characteristics of Overview - Case claim, claim edits, claim Management - Case submission type, prior Identification and Creation authorization, and client). IV.N.6.b Operations Phase - Business Architecture Must auto-populate fields and Overview - Case values on all case-related forms Management - Case and web-based tools including Identification and Creation exclusionary provider data. Must have access to internal and external agency databases to extract data to pre-populate index fields, and/or values (e.g. MMIS, provider data, MMIS member data, IV.N.6.b Operations Phase - Electronic Health Records). Business Architecture Interfaces between State Overview - Case Contractors for data will be Management - Case arranged to facilitate the Identification and Creation IV.N.6.b Operations Phase - Business Architecture Must suggest and supply data and Overview - Case information from other sources to Management - Case pre-populate values (address, Identification and Creation licensure). IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Must identify and link related case Identification and Creation data and activities. Must include IV.N.6.b Operations Phase - text note functionality (e.g. Business Architecture keyword search, sort functions) for Overview - Case cases.
Management - Case Identification and Creation IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Identification and Creation Must receive, record and funnel all initial cases into a queue for assessment, assignment and investigation. IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Identification and Creation Must assign caseload “weights” to cases (e.g., characteristics of claim, claim edits, claim submission type, prior authorization, and client). IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Identification and Creation Must auto-populate fields and values on all case-related forms and web-based tools including exclusionary provider data. IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Identification and Creation Must have access to internal and external agency databases to extract data to pre-populate index fields, and/or values (e.g. MMIS, provider data, MMIS member data, Electronic Health Records). Interfaces between State Contractors for data will be arranged to facilitate the IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Identification and Creation Must suggest and supply data and information from other sources to pre-populate values (address, licensure). IV.N.6.b Operations Phase - Business Architecture Overview - Case Management - Case Identification and Creation Must identify and link related case data and activities. IV.N.6.b Operations Phase - Business Architecture Overview - Case Must include text note functionality (e.g. keyword search, sort functions) for cases.
Revised%20Attachment%20B%20-%20Business%20and%20Technical%20Requirements%20Matrix.docx