IV.N.6.d Operations Phase - Business Architecture Must allow managers to track Overview - Case investigator caseloads, missed Management - Audit Cases deadlines and aging cases. IV.N.6.d Operations Phase - Business Architecture Overview - Case Must maintain a complete history Management - Audit Cases and audit trail of all cases. IV.N.6.d Operations Phase - Must provide the functionality to Business Architecture analyze caseloads, clearance Overview - Case rates, dispositions and other Management - Audit Cases management data. IV.N.6.d Operations Phase - Business Architecture Overview - Case Must provide time tracking Management - Audit Cases and complete history/audit trails. IV.N.6.d Operations Phase - Business Architecture Overview - Case Must retain all data on-line for a Management - Audit Cases period of time defined by the State. Must process and load encounter IV.N.7 Operations - and FFS claims to the data Business Architecture warehouse received in HIPAA and Overview Encounter NCPDP standard formats as – Processing applicable by claim type. Must validate that encounter and IV.N.7 Operations Phase - FFS claims are in compliance with Business Architecture and NCPDP standards and Overview Encounter operating rules as applicable by – Processing claim type. Must perform integrity edits as IV.N.7 Operations - directed by the State. Integrity Business Architecture edits are those that would be in Overview Encounter addition to HIPAA compliance – Processing edits. IV.N.7 Operations Phase - Business Architecture Must maintain all applicable Overview Encounter reference for encounter – Processing processing purposes.
IV.N.6.d Operations Phase - Business Architecture Overview - Case Management - Audit Cases Must allow managers to track investigator caseloads, missed deadlines and aging cases. IV.N.6.d Operations Phase - Business Architecture Overview - Case Management - Audit Cases Must maintain a complete history and audit trail of all cases. IV.N.6.d Operations Phase - Business Architecture Overview - Case Management - Audit Cases Must provide the functionality to analyze caseloads, clearance rates, dispositions and other management data. IV.N.6.d Operations Phase - Business Architecture Overview - Case Management - Audit Cases Must provide time tracking and complete history/audit trails. IV.N.6.d Operations Phase - Business Architecture Overview - Case Management - Audit Cases Must retain all data on-line for a period of time defined by the State. IV.N.7 Operations - Business Architecture Overview – Encounter Processing Must process and load encounter and FFS claims to the data warehouse received in HIPAA and NCPDP standard formats as applicable by claim type. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must validate that encounter and FFS claims are in compliance with and NCPDP standards and operating rules as applicable by claim type. IV.N.7 Operations - Business Architecture Overview – Encounter Processing Must perform integrity edits as directed by the State. Integrity edits are those that would be in addition to HIPAA compliance edits. IV.N.7 Operations Phase - Business Architecture Overview – Encounter Processing Must maintain all applicable reference for encounter processing purposes.
Revised%20Attachment%20B%20-%20Business%20and%20Technical%20Requirements%20Matrix.docx