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Manage Business Relationship Information

Standards Management

Description

The Manage Business Relationship Information business process maintains the agreement between the State Medicaid Agency (SMA) and the other party such as the intrastate, interstate, and federal agencies. This includes routine modifications to required information such as authorized signers, addresses, terms of agreement, Key Performance Indicator (KPI), and data exchange standards.

Business Process Template

Trigger events
Environment-based
  • Receive agreement modifications (e.g., create, update, or delete).
Interaction-based

None published

Results
  • Modified business relationship agreement.
  • Alert to send notification to business partner of agreement.
  • Tracking information as needed for measuring performance and business activity monitoring.
Business process steps
  • 1. START: Receive agreement updates.
  • 2. Agency logs request for modification.
  • 3. Validate information submitted is correct and as complete as possible. Information complies with syntax criteria and submitter has completed all required fields.
  • 4. Validate that the provided information is authentic.
  • 5. Staff records modification to business relationship agreement.
  • 6. END: Send alert to notify business partner of modification.
Predecessor processes
Successor processes
Shared data
  • Business Partner data store including service agreement information
  • Contractor data store including contract information
Constraints

Modifications include all information in the agreement, and depend on the type of agreement and service level requirements associated with the agreement.

Failures
  • Information does not comply with syntax criteria.
  • Not all required information provided.
  • Staff is unable to authenticate information provided.
Performance measures
  • Time to complete business process = within __ days
  • Accuracy with which edits are applied = ___%
  • Consistency of decisions and disposition = ___%
  • Error rate = __% or less

Source: CMS MITA 3.0 Business Process Template, Business Relationship Management BPT.pdf, pages 4-6.

Business Capability Model (10 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.
  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 regarding updating the business relationship.
  3. LEVEL 3SMA automates process to the full extent possible within the intrastate. SMA and its trading partners (other agencies, entities, and providers) agree to automatic updates to the Service Level Agreement (SLA) governing the exchange of health care information.
  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.
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 to modify and amend business relationships and their relevant manual and electronic documentation.
  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 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. SMA has informal agreements with other business partners.
  2. LEVEL 2SMA collaborates with other agencies and entities to adopt HIPAA standards and Electronic Data Interchange (EDI) transactions. SMA has business partner agreements with other entities including terms for amending and modifying business partner agreements.
  3. LEVEL 3SMA collaborates with other intrastate agencies and entities to adopt national standards, and to develop and share reusable business services for amending and modifying business partner agreements.
  4. LEVEL 4SMA collaborates with other interstate agencies and entities to adopt national standards, and to develop and share reusable processes for amending and modifying business partner agreements.
  5. LEVEL 5SMA collaborates with agencies and entities for national (and international) interoperability improvements that maximize automation of routine operations for amending and modifying business partner agreements.

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 can require many weeks due to the need to customize each agreement.
  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 five (5) business days or less.
  4. LEVEL 4Information is available in near real time. SMA has interstate interoperability, which further improves timeliness over Level 3. Process completes in three (3) business days or less.
  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 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 for information exchange by 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. Process is dependent on postal or other hard copy delivery services.
  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. Accessibility is no more than 60 seconds.
  4. LEVEL 4SMA obtains information easily and exchanges with interstate agencies and entities. Accessibility is no more than 30 seconds.
  5. LEVEL 5SMA obtains information easily and exchanges with national agencies and entities. Accessibility is no more than 15 seconds.

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.
  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 14-20.

Other Business Relationship Management processes

Establish Business RelationshipManage Business Relationship CommunicationTerminate Business Relationship