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Manage Business Relationship Communication

Standards Management

Description

The Manage Business Relationship Communication business process receives requests for information, appointments, and assistance from business partners, such as inquiries related to a Service Level Agreement (SLA). This business process includes the log, research, development, approval and delivery of routine or ad hoc messages. Information communicated by a variety of methods such as email, mail, publication, mobile device, facsimile, telephone, web or Electronic Data Interchange (EDI).

Business Process Template

Trigger events
Environment-based
  • Receive inquiry from business partner.
  • Request to send information packages such as a SLA or a Key Performance Indicator (KPI).
  • Receive request for assistance, such as a request for training or change in business partner information.
  • Periodic timetable (e.g., monthly) is due for sending information (e.g., within 24 hours of new business partner agreement and periodic communications such as newsletters or other agency communications).
Interaction-based
  • Receive requests from other business processes to develop and produce communications for business partners such as alerts from Establish Business Relationship business process.
  • Receive inquiries originating from customer help desk through Manage Business Relationship Information business process.
Results
  • Business partner receives appropriate assistance, communication, and/or information packages.
  • Tracking information as needed for measuring performance and business activity monitoring.
Business process steps
  • 1. START: Receive request for communication.
  • 2. Validate information submitted is correct and as complete as possible. Information complies with syntax criteria and requestor has completed all required fields.
  • 3. Validate that the provided information is authentic.
  • 4. Agency logs request for communication.
  • 5. Determine content and method of communication (e.g., email, mail, publication, mobile device, facsimile, telephone, web, or Electronic Data Interchange (EDI)).
  • 6. Prepare content that is linguistically, culturally, and competency appropriate for the communication in agreed upon format.
  • 7. Review and approve communication.
  • 8. Generate communication in agreed upon format.
  • 9. Agency logs communication message.
  • 10. END: Evaluate the efficacy of the communication (e.g., customer satisfaction, first time resolution rate).
Predecessor processes
Successor processes
Shared data
  • Business Partner data store including service agreements information
  • Contractor data store including contract information
Constraints

The State Medicaid Agency (SMA) and its business partners agree on the content of the communications. Content depends on the business relationship. Content may be standards-based. Communication complies with federal and state regulations that may vary by state. Business partner may have communication barriers such as lack of internet or phone access. Business partner is unable to access needed or requested information.

Failures
  • The SMA is unable to provide linguistically, culturally, or competency appropriate information.
  • Delivery failures due to erroneous contact information or lack of contact information.
Performance measures
  • Time to complete response: By phone __ minutes; by email __hours; by mail __ days
  • Accuracy of communications = __%
  • Communications successfully delivered = __%

Source: CMS MITA 3.0 Business Process Template, Business Relationship Management BPT.pdf, pages 2-4.

Business Capability Model (11 questions)

Each capability question defines five maturity levels, from Level 1 through Level 5.

Business Capability Descriptions

Is the process primarily manual or automatic?
  1. LEVEL 1The process consists primarily of manual activity to accomplish tasks. SMA exchanges communications with other parties via mail, facsimile, or telephone.
  2. LEVEL 2SMA uses mix of manual and automatic processes to gather, record, communicate, and distribute information to SMA leadership, other state agencies, and participating providers.
  3. LEVEL 3SMA automates process to the full extent possible within the intrastate. SMA supports automatic communications with its trading partners (other agencies, entities, and providers) via a SMA web portal. Portal includes usability features or functions that accommodate the needs of persons with disabilities, including those who use assistive technology.
  4. LEVEL 4SMA automates process to the full extent possible across the interstate.
  5. LEVEL 5SMA automates process to the full extent possible across the nation.
Is communication linguistically, culturally, and competency appropriate?
  1. LEVEL 1Functionally, linguistically, culturally, and competency appropriate communications are lacking because they are difficult and costly to produce.
  2. LEVEL 2Communication is functionally, linguistically, culturally, and competency appropriate, but at great expense, or SMA has state defined parameters (e.g., only two (2) languages used).
  3. LEVEL 3SMA automates process to the full extent possible across the intrastate. Use of electronic communications makes provision of functionally, linguistically, culturally, and competency appropriate communications more cost-effective.
  4. LEVEL 4SMA automates process to the full extent possible within the region.
  5. LEVEL 5SMA automates process to the full extent possible across the nation.
Does State Medicaid Agency use standards in the process?
  1. LEVEL 1SMA focuses on meeting compliance thresholds for state and federal regulations using state-specific standards.
  2. LEVEL 2SMA applies a mix of HIPAA and state-specific standards.
  3. LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards for intrastate exchange of information.
  4. LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for clinical and interstate information exchange.
  5. LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national exchange of information.
Does the State Medicaid Agency collaborate with other agencies or entities in performing the process?
  1. LEVEL 1Very little collaboration occurs with other agencies to standardize information exchange or business tasks.
  2. LEVEL 2SMA collaborates with other agencies and entities to adopt HIPAA standards and EDI transactions for business partner communications.
  3. LEVEL 3SMA collaborates with other intrastate agencies and entities to adopt national standards, and to develop and share reusable business services for business partner communications.
  4. LEVEL 4SMA collaborates with other interstate agencies and entities to adopt national standards, and to develop and share reusable processes for business partner communications.
  5. LEVEL 5SMA collaborates with agencies and entities for national (and international) interoperability improvements that maximize automation of routine operations.

Business Capability Quality: Timeliness of Process

How timely is this end-to-end process?
  1. LEVEL 1Process meets threshold or mandated requirements for timeliness (i.e., the process achieves results within the time specified by law or regulation). The process is dependent on normal timeframes found in using United States Postal Service, facsimile, or telephone.
  2. LEVEL 2Process timeliness improves through use of automation. Timeliness reduces the timeframes of Level 1.
  3. LEVEL 3Timeliness improves via state and federal collaboration, use of information sharing, standards, and regional information exchange hubs. Process completes in less than one (1) business day.
  4. LEVEL 4Information is available in near real time. SMA has interstate interoperability, which further improves timeliness over Level 3.
  5. LEVEL 5Information is available in real time. Processes improve further through connectivity with other States and with federal agencies. Results are almost immediate.

Business Capability Quality: Data Access and Accuracy

How accurate is the information in the process?
  1. LEVEL 1Use of direct data entry for information collection is manually intensive and susceptible to inconsistent or incorrect information. Stakeholders are unable to rely on information for decision-making.
  2. LEVEL 2HIPAA standard transactions improve accuracy of information but the decision-making process may be erroneous or misleading. Accuracy is higher than at Level 1.
  3. LEVEL 3Automation of information collection increases the reliability of SMA internal information. External sources of information use MITA Framework for information exchange. Decision-making is automatic using intrastate standardized business rules definitions. Accuracy rating is at 99% or higher.
  4. LEVEL 4Automation of information collection increases the reliability of SMA internal and external sources of information. SMA adopts MITA Framework and industry standards for information exchange with interstate agencies. Decision-making is automatic using regional standardized business rules definitions. Accuracy rating is at 99% or higher.
  5. LEVEL 5SMA adopts MITA Framework for national information exchange. Decision-making is automatic using national standardized business rules definitions. Accuracy rating is at 99% or higher.
How accessible is the information in the process?
  1. LEVEL 1SMA stores information in disparate systems including paper storage and obtains information manually.
  2. LEVEL 2SMA stores information in disparate systems, but automation and HIPAA standards increase accessibility over Level 1.
  3. LEVEL 3SMA obtains information easily and exchanges with intrastate agencies and entities based on MITA Framework and industry standards. Accessibility is greater than Level 2.
  4. LEVEL 4SMA obtains information easily and exchanges with interstate agencies and entities. Accessibility is greater than Level 3.
  5. LEVEL 5SMA obtains information easily and exchanges with national agencies and entities. Accessibility is greater than Level 4.

Business Capability Quality: Cost Effectiveness

What is the cost to perform the process compared to the benefits of the results?
  1. LEVEL 1High relative cost due to low number of automatic, standardized tasks.
  2. LEVEL 2Automation improves process and allows focus on exception resolution, improving cost effectiveness ratio over Level 1. SMA reduces the cost per unit of communication.
  3. LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards further improving cost effectiveness ratio over Level 2.
  4. LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for interstate information exchange. SMA increases cost effectiveness ratio over Level 3.
  5. LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national (and international) information exchange. SMA increases cost effectiveness ratio over level 4.

Business Capability Quality: Effort to Perform; Efficiency

How efficient is the process?
  1. LEVEL 1Process is labor intensive. There is wasted effort or expense to accomplish tasks. Process meets minimum state process guidelines and SMA performance standards. Efficiency is low.
  2. LEVEL 2Automation and state standards increase productivity. Efficiency is higher than Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving efficiency to 95% or higher.
  4. LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving efficiency to 98% or higher.
  5. LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving efficiency to 98% or higher.

Business Capability Quality: Accuracy of Process Results

How accurate are the results of the process?
  1. LEVEL 1Manual processes result in greater opportunity for human error. Accuracy is low.
  2. LEVEL 2Automation and standardized business rules definitions reduce error and improve accuracy above Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving accuracy to 90% or higher.
  4. LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving accuracy to 98% or higher.
  5. LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving accuracy to 98% or higher.

Business Capability Quality: Utility or Value to Stakeholders

Does the business process satisfy stakeholders?
  1. LEVEL 1Stakeholders lack confidence in information negatively affecting stakeholder satisfaction with the process.
  2. LEVEL 2Automation and standardization provides clear and useful information. Stakeholder satisfaction is greater than Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving stakeholder satisfaction to 90% or higher. SMA uses survey or questionnaire for information collection.
  4. LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving stakeholder satisfaction to 95% or higher.
  5. LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving stakeholder satisfaction to 98% or higher.

Source: CMS MITA 3.0 Business Capability Model, Business Relationship Management BCM.pdf, pages 7-14.

Other Business Relationship Management processes

Establish Business RelationshipManage Business Relationship InformationTerminate Business Relationship