Provider/Contractor Management (P/CM) P/CM: Award Health Services Contract Item Details Description The Award Health Services Contract business process receives proposals, verifies proposal content against RFP requirements, applies evaluation criteria, designates contractor/vendor, posts award information, entertains protests, resolves protests, negotiates contract, notifies parties. MITA Source Process Name: Award Health Services Contract Reference Source Process Business Area: Contractor Management References: Part 1 Appendix C, Business Process Model Details Part 1 Appendix D, Business Process Capability Matrix Details http://www.cms.hhs.gov/MedicaidInfoTechArch/04_MITAFramework.asp Sample Data Contractor Master Registry Other per Type of Contractor P/CM: Award Health Services Contract: Maturity Levels Level 1 Level 2 Level 3 Level 4 Level 5 Indeterminate Application data Application data Level 3 Level 3 and 4 format for are standardized are standardized capabilities capabilities proposal data. within the state. nationally. All augmented by augmented by Much of the Contractors can verifications can some new national information is submit be automated. capabilities. interoperability, manually applications via a Rules are External and permitting the validated. Staff portal. consistently internal validation enrollment process contact external Verifications are a applied. Decisions sources to send inquiries to and internal mix of manual and are uniform. Some automatically send any other agency, document automated steps. manual steps may notice of change in state, federal, or verification Consistency is continue. contractor status. other entities sources via phone, improved. Turnaround time Recertification regarding the fax. Decisions Requires fewer can be immediate. notices are status of a may be staff. Process takes Services will automatically contractor. Any inconsistent. less time than created for the generated. Clinical data exchange Requires large Level 1. following steps data, if useful in partner can send a numbers of staff. and can be shared. processing the notification Decisions may 1. Verify enrollment request regarding a take several days. Credentials is accessible by contractor enrolled 2. Verify ID direct access. with the state 3. Assign ID Manual steps only Medicaid program. 4. Assign Rates required for 5. Negotiate exception Contract. handling. Automation Level 1 Level 2 Level 3 Level 4 Level 5 All/mostly paper Internal processes Internal agency External agency Non-state entity mostly automated processes/interfaces processes/interfaces processes/interfaces mostly automated mostly automated mostly automated VA As Is: The CSBs BHDS is at Level 2. are between a 1 & 2. There is some consistency within counties but not across all 40 CSBs. VA To Be: The goal Virginia requires for the CSBs is to paper submission of work toward more proposals & consistency and contracts. Unless level 2. this requirement is repealed, full automation will not occur. BHDS does electronically release its RFPs. Standards Level 1 Level 2 Level 3 Level 4 Level 5 Use few or no Internal processes Internal agency External agency Non-state entity national standards use national processes/interfaces processes/interfaces processes/interfaces standards mostly use national mostly use national mostly use national standards standards standards VA As Is: The CSBs and BHDS are at level 1. VA To Be: There are no national standards known so it is unlikely that there will be progression. Cross Coordination Level 1 Level 2 Level 3 Level 4 Level 5 Little/no Internal agency Internal agency External agency Non-state entity coordination across operational program processes program and program and processes or with processes coordinated operational operational other programs coordinated processes processes coordinated coordinated VA As Is The CSBs and BHDS are at level 2. VA To Be The goal will be to work toward level 3 with greater cross coordination. Client Data Level 1 Level 2 Level 3 Level 4 Level 5 Little/no access to Internal processes Internal agency External agency Non-state entity client specific data have access to processes have processes have processes have client access to client access to client access to client specific data specific data specific data specific data VA As Is: The CSBs and BHDS are at level 1. Any data that is shared is de- identified. VA To Be: We don’t see change in this practice as likely. Interoperability Level 1 Level 2 Level 3 Level 4 Level 5 None Limited Interoperability with Interoperability with Interoperability with interoperability internal agency external agency non-state entity internally or limited systems other than systems other than systems to claims processing claims processing claims processing systems VA As Is: N/A VA To Be: N/A