IV.N.7 Operations - Business Architecture Must maintain a method to Overview Encounter distinguish between encounter and – Processing FFS claim records. IV.N.7 Operations - Business Architecture Overview Encounter Must reject claims that fail – Processing compliance edits. IV.N.7 Operations Phase - Business Architecture Must flag, capture and report on Overview Encounter encounters and claims that fail – Processing integrity edits. IV.N.7 Operations Phase - Must support a workflow and Business Architecture method to work with the MCO for Overview Encounter submission of a corrected – Processing encounter IV.N.7 Operations Phase - Must provide a detailed integrity Business Architecture edit report describing the reason Overview Encounter for the integrity flag and work with – Processing MCO to resolve and resubmit. IV.N.7 Operations Phase - Business Architecture Must provide management Overview Encounter reconciliation reports for rejected – Processing encounters and claims resolution. IV.N.7 Operations Phase - Business Architecture Overview Encounter Must provide online work queues – Processing for flagged claims resolution. IV.N.7 Operations Phase - Must capture and report on other Business Architecture types of payment records including Overview Encounter MCO supplemental payments such – Processing as maternity Kick Payments. IV.N.7 Operations Phase - Business Architecture Must report on content of the Overview Encounter database via dashboards, static – Processing and ad-hoc reports. IV.N.7 Operations Phase - Business Architecture Overview Encounter Must report on the activity of – Processing encounter and claim receipts.
IV.N.7 Operations - Business Architecture Overview – Encounter Processing Must maintain a method to distinguish between encounter and FFS claim records. IV.N.7 Operations - Business Architecture Overview – Encounter Processing Must reject claims that fail compliance edits. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must flag, capture and report on encounters and claims that fail integrity edits. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must support a workflow and method to work with the MCO for submission of a corrected encounter IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must provide a detailed integrity edit report describing the reason for the integrity flag and work with MCO to resolve and resubmit. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must provide management reconciliation reports for rejected encounters and claims resolution. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must provide online work queues for flagged claims resolution. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must capture and report on other types of payment records including MCO supplemental payments such as maternity Kick Payments. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must report on content of the database via dashboards, static and ad-hoc reports. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must report on the activity of encounter and claim receipts.
Revised%20Attachment%20B%20-%20Business%20and%20Technical%20Requirements%20Matrix.docx