| Operational/ Functional Area | Scope | Activities | SME Resourcing Considerations | Expected Deliverables |
| Phase 2 Planning | - Evaluation of opportunities
- Capture business requirements specifications to use for SOW
| - Perform SME interviews.
- Gap analysis (Enhancements coming out of testing)
- Perform impact analysis.
- Prioritization of proposed scope
- Governance development
| - Coordination with all teams during Phase 1. Capitalize on coordination of testing and improvement recommendations from team.
- Primary engagement with: Test Lead and Change Manager
| - Business case document
- Workflows & SOPs of Day 1 functionality
- Strategic Playbook
- Financial planning
- HR impacts (resulting from new tools and processes)
|
| Faxing Integration | - API Integration for Inbound & Outbound
- Payer Authorization Portal Integrations
- Prior Auth & Decisioning Impact Evaluation
| - Document new API fax process E2E
- Work with Central IT Fax Services to capture Requirements.
- Draft funding request if required.
- Work with HC Enterprise Architect for County approval
| Coordination with HCIT Fax, HHIT, Rx, UM and Compliance | - Workflow for API Implementation
- Support Documentation
- Test Cases
|
| Operational/ Functional Area | Scope | Activities | SME Resourcing Considerations | Expected Deliverables |
| Case Management | - Assessments
- Care plan development
- Care Giver Management
- Integration with Support Services
| - Work with Define requirements for Surveys & Assessments (~ 30)
- Advocacy Integration & Access to 3rd party tools to support services.
| Primary engagement with: CCM | - Business Requirements for in-house development
- SOPs
- Workflows
|
| Finance (Risk Management) | - CDPS to Support Finance Activities
- Evaluation of data driven care management activities in new system
| - Capture requirements for a Risk Management solution
- Document As Is workflow and integration with other processes.
- Evaluation of OOB reporting to determine improvement opportunities
| Primary engagement with: Finance | |
| Restricted Recipients | - Improved DHS data integrations
| - Evaluation of process improvement activities to reduce manual touch-points.
- Review & refinement of processes with UM & Pop Health
| Primary Engagement: UM, Quality and Compliance | - Updated process workflows
- BRD for Guidingcare changes & integration file requirements
|
| Transportation | - Customer Care
- Transportation providers
- After Hours Authorization
- FACETS
- Reconciliation
- Compliance/Audit
| - Capture Improvement & Feature enhancements during testing
- Document reconciliation process for support, process improvement/automation
- Document Defect Management process (loss process)
- Develop SOPs for Customer Support
- Update Transportation provider communications
| Primary Engagement: Customer Care, Claims, Integrations | - Updated workflows
- SOP for reconciliation process(es)
- Recommendations on automation processes to reduce losses
|
| FACETS/Authorization Optimization | - Claims (Cognizant Collaboration)
- Customer Care
- Reconciliation
- Compliance/Audit
| - Collaboration with Cognizant on new Claims process project
- Document new workflow
- Capture requirements for changes to feeds, integration and cross-walks
| Primary Engagement: Integrations, Claims, IT | - Requirements
- Test cases
- Workflows
|
| New Data Ingestion | | | Primary Engagement: Quality, Pop Health, IT, Integrations | |
| Operational/ Functional Area | Scope | Activities | SME Resourcing Considerations | Expected Deliverables |
| Quality Measures | - HEDIS
- New Enrollee Programs
Expanding SNP activities and KPIs | - Workflow optimization of Campaign Management activities
- Program Development documentation & Workflow
| Primary engagement with: Quality Following critical compliance Black dates | - SOPs
- Business Requirements for in-house development
- Identification of data needs & feeds
|
| Population Health | | - Work with data scientist to determine critical system data requirements.
- Capture Stakeholder impacts (support outreach/Quality and patient engagement activities)
| Engagement with the new Pop Health team (Director and data scientist) | - Data source mapping documentation
- System requirements
- Business requirements
|
| Authorization Portal (Provider Access) | - Interoperability
- Provider Engagement
| - Journey Mapping
- Interview HH leadership for goals & Objectives for solution
- Develop Business Requirements
- Survey Providers
- Identify integration touch-points
| Primary engagement: TBD, unclear who will own this new process | - Advancing Interoperability Assessment (HL7 preparedness)
|
| Member Engagement Portal | - Outreach management
- Content management
- Setup & Oversight
- Member enrollment integration
- Provider Visit tracking
- Field office visit tracking
- Material distribution
| - Define requirements & KPIs
- Administrative cost saving analysis
- Touch-point analysis (what operational areas will be impacted by the change, and have new processes)
| Primary Resource: Change Manager, Medical Administration, Campaign Management | - Impact Analysis
- Business Objective Summary
- HR Hiring/restructuring considerations
- Performance KPIs
|
