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Care Select NotificationCO 1540

Table of Contents

BUSINESS PROCESS SPECIFICATIONS 3

SYSTEM PROCESS SPECIFICATIONS 5

WINDOW DEFINITION: N/A 7

WEB PAGE DEFINITION 9

REPORT DEFINITION: N/A 19

Interface/Extract Definition: N/A 21

Business Design OverviewProcess Overview Provides the ability for IHCP providers to report when a Care Select

member presents to a facility for Emergency Room, Outpatient Surgery, and Inpatient Care services.

Process Owners Managed Care UnitSubsystem Prior Authorization Process Triggers When a Care Select member presents at a facility for Emergency Room,

Outpatient Surgery or Inpatient Select Care services.Inputs Providers will click on the Care Select Notification button on the Eligibility

Inquiry page to enter date of treatment, type of service and presenting signs, symptoms, or diagnosis.

Outputs The following information will be available for reporting:Date of TreatmentMember’s RIDMember’s Name, Address and Phone numberPresenting Signs, Symptoms and/or DiagnosisFacility Name, Address and Phone numberFacility NPIPrimary Medical Provider (PMP) and Phone number

Additional Information N/ARequirement Number(s) H1 Create a Care Select Notification Process for the Care

Management Organization (CMO).

1.1. Modify Web interchange to accept Care Select Notification when a member receives Emergency Room (ER), Outpatient

Surgery, or Inpatient Care services.

l EDS INTERNAL DOCUMENT l Business Process Specifications l February 2009

BUSINESS DESIGN

1.2. Provide the ability to capture member’s information.The following will be included:• Member’s name, address and phone number• Member’s RID• Member’s presenting signs, symptoms, or

diagnosis.• Date of treatment

H2 Provide the ability to report member information to the CMOs.The following is the information will be included:• Facility’s name, address and phone number• Facility’s NPI• Member’s name, address and phone number• Member’s RID• Member’s presenting signs, symptoms, and/or

diagnosis.• Date of treatment• Primary Medical Provider (PMP) and phone

number

Process Flowchart <Provide a link to the Word or JPG version of the Visio Flowchart that outlines the process>

Business Process Specifications l September 2008 2

Business Process SpecificationsBusiness Process Specifications Overview – Describe any changes needed for the business processes. Changes include edit resolution procedures, addition of a new form for billing, new instruction for data entry, or any other business process.

Information must be gathered from Subject Matter Experts in each affected Business Unit. Describe in detail the steps required to perform the Business Process.

Step Action Chart for Business Process Specifications #1Entering Care Select Notification

Step Performed By Step Description1 Care Select member Presents for Emergency Room, Outpatient Surgery or Inpatient Care

services.2 Provider Verifies eligibility via Web interChange.3 Provider Click on to the Care Select Notification button on Eligibility Inquiry

page.4 Provider Enter the following information on the Care Select Notification page:

Date of TreatmentType of ServicePresenting signs, symptoms or diagnosis

5 Provider Click on the save button. The Care Select Notification page will disappear.Note:If Care Select member is not eligible, the Care Select Notification button will not display.

Step Action Chart for Business Process Specifications #2Retrieving Care Select Notification

Step Performed By Step Description1 CMO Goes to Web interChange to enter log on and password.2 CMO Click on the Care Select Inquiry button.3 CMO From the Care Select Notification Inquiry page, enter From and To

Date and click on the Search button. The information will display lower section.

4 CMO Click on to the Export List button to export data to a common separate variable (.CSV) file.Note:From Date and To Date can be a date span or if date is for a specific date of service, enter the same date in the From Date and To Date fields.Type of Service field will allow user to filter service types.


System Process SpecificationsSystem Process Specifications Overview – This document contains the business rules at a high level for internal processing of data. Process specifications must be defined for any new or adjusted business rules which govern the systematic processing of data and impact the systems output. This document should be used for changes to any system process, including process logic which supports screens and reports.

Step Action Chart for System Process Specifications #1Entering Care Select Notification

Step Step Description1 Eligibility is verified via Web interChange for Care Select member. The Care Select

Notification button will appear only if the member is eligible.2 If the CMO user clicks on to the Care Select Notification button, the Care Select

Notification page will appear. 3 Once data is entered and saved, the data will be saved on the Care Select Notification

table.

Technical Design SectionFor Completion By the Technical Team Only

Window / Module Name: Window Title: Prerequisites:Data Flows:Ancestor Window: <Name of the Powerbuilder Ancestor window.>Window Event: <Describe each window or data window event that extends or

overrides the corresponding ancestor event.>Specifications:


Step Action Chart for System Process Specifications #2Retrieving Care Select Notification

Step Step Description1 When CMO user logs on to Web interchange and click the Care Select Notification

Inquiry button, populate CMO ID associated with the user.2 When a date is entered in the From and To Date field and the Search button is clicked,

the data from Care Select Notification table will populate from the search date(s) in the Reported Information section.

4 When the Export List button is clicked, export data to .CSV file.Note:Type of Service field will allow the user to filter the service types.

When the Reset button is clicked, the From and To Date field will be cleared from the Care Select Notification Inquiry page.





Window Definition: N/AWindows – This section contains Window information by subsystem. Window layouts may be attached separately if necessary. Repeat the full Business and Technical Window chart for each Window created or changed.

Business Design Section

Window #1Window Title <Title of the window.> What is the window called – if this is a modification to a

current window then that name would go here – if it is a new window the business unit should have ideas on what they want to call the window – it needs to be concise

Window Name <Name of Powerbuilder window. Optional > Window Function

<Briefly describe the business function of the Window, how, and why it is used.>

External Window Description

<Description in business terms that will be used to update system documentation in the Project Workbook data entry portal.>

Window Layout

<Insert a screen print of the window here.>

For the following items: Complete all items for new windows. When changing existing windows, only provide information for the items that have changed and indicate N/A for unchanged items. Initiated By <List the window name(s) which calls this windowWindow Mode <Describe the window mode (route/add/change/delete/inquiryWindow Display Rules

<List the sort order of displayed data for each display window.>

Window(s) it Calls

<List the window name(s) that this window will open, the event that opens it, and if it should open a new window.>

Event Window Name Window Title New Window?

Window Element Entry Rules

<Describe any validation editing needed for each window element, such as the entry must be a valid value, numeric, date, and so forth.>

Cross Edits <List any special conditions in which the value of one element is dependent on the value or existence of some other data.>

Window Security

<Describe the security features of the window. List the security profiles which have access to open the window. List any window controls which are secured and which profiles have access to use them.>


Window / Module Name: Window Title: Prerequisites:


Data Flows:Ancestor Window: <Name of the Powerbuilder Ancestor window.>Window Event: <Describe each window or data window event that extends or



Web Page DefinitionWeb Pages - This section contains Web Page information by subsystem. Web Page layouts may be attached separately if necessary. Repeat the Web Page chart, business and technical, for each new or updated Web page.

Business Design SectionEligibility Inquiry page

Section #1

Home URL https://interchange.indianamedicaid.comPage Title Eligibility InquiryPage Name <Name of Web page. Optional> TECHPage Function This page gives the ability for IHCP providers to verify eligibility of a Medicaid

recipient. External Page Description

This page gives the ability for IHCP providers to verify eligibility of a Medicaid recipient.

For the following items: Complete all items for new Web pages. When changing an existing Web page, only provide information for the items that have changed and indicate N/A for unchanged items. Initiated By N/APage Mode N/APage Display Rules

Add ‘Care Select Notification’ button in the Managed Care Information section.

Page(s) it Calls User Action Web Page Name Web Page Title Open in New

Window?Click on the ‘Care Select Notification’ button

Care Select Notification Care Select Notification

yes

Page Element Entry Rules

N/A

Cross EditsRelationships between fields

Display the ‘Care Select Notification’ button only when a member is eligible for Care Select program.

Page Security N/A


Page Layout

Care Select Notification





Business Design SectionCare Select Notification page

Section #2

Home URL https://interchange.indianamedicaid.comPage Title Care Select NotificationPage Name <Name of Web page. Optional> TECHPage Function This page provides the ability for facilities to report when a Care Select member

presents for ER, Outpatient Surgery or Care Select Care services. External Page Description

This page provides the ability for facilities to report when a Care Select member presents for ER, Outpatient Surgery or Care Select Care services.

For the following items: Complete all items for new Web pages. When changing an existing Web page, only provide information for the items that have changed and indicate N/A for unchanged items. Initiated By Care Select Notification buttonPage Mode Update Page Display Rules

Care Select NotificationDate of Treatment:

Types of Services:Inpatient Care:Outpatient Surgery:Emergency Room:

Presenting Signs, Symptoms or Diagnosis:

Save buttonCancel button

Page(s) it Calls

N/AUser Action Web Page Name Web Page Title Open in

New Window?


Care Select NotificationDate of Treatment: Standard date field. Date can be entered as either mm/dd/yy or mm/dd/yyyy format, with or without the slashes. Valid date must be converted and displayed in mm/dd/yyyy format. Standard Date control is also available to populate the Date of Treatment field. Data entered must be a valid date. Required.

Types of Services:Inpatient Care: Radio button. Default to blank field. Required if Outpatient Surgery or Emergency Service is not chosen.Outpatient Surgery: Radio button. Default to blank field. Required if Care Select Surgery or Emergency Service is not chosen.Emergency Room: Radio button. Default to blank field. Required, if Outpatient Surgery or Care Select Care is not chosen.

Presenting Signs, Symptoms, or Diagnosis: Up to 100-digit alphanumeric, limit of 100 characters entry on the field. Force upper case after entry. Allow space, glitch, dash, and period. Default to blank field. Required.


Save button: Clicking on the button will cause the following:Submit the information for Care Select Notification table.

Cancel button: Clicking on the button will cause the following:Web page will close and data will not be saved.


N/A

Page Security User must have access to Eligibility Inquiry page in Web interChange.

Page Layout Care Select NotificationCare Select Notification

Care Select Notification

Inpatient Care:

Emergency Room:

Outpatient Surgery:

Type of Services :

Presenting Signs , Symptoms or Diagnosis :

Save Cancel

Date of Treatment :



overrides the corresponding ancestor event.>


Specifications:

Business Design SectionWeb interChange page

Section #3

Home URL https://interchange.indianamedicaid.comPage Title Web interChangePage Name <Name of Web page. Optional> TECHPage Function This is the home page of Web interChange. External Page Description

This is the home page of Web interChange.

For the following items: Complete all items for new Web pages. When changing an existing Web page, only provide information for the items that have changed and indicate N/A for unchanged items. Initiated By N/APage Mode N/APage Display Rules

Add ‘Care Select Inquiry’ button

Page(s) it Calls User Action Web Page Name Web Page Title Open in New

Window?Click on ‘Care Select Inquiry’ button

Care Select Notification Inquiry

Care Select Notification Inquiry

yes


Care Select Inquiry: Clicking on this button will allow the ‘Care Select Notification Inquiry’ page to display.


N/A

Page Security User must have CMO security access to Care Select Notification Inquiry in Web interChange.


Page Layout

Care Select Inquiry





Business Design SectionCare Select Notification Inquiry page

Section #4

Home URL https://interchange.indianamedicaid.comPage Title Care Select Notification InquiryPage Name <Name of Web page. Optional> TECHPage Function This page gives the ability for the CMOs to retrieve Care Select Notification data. External Page Description

This page gives the ability for the CMOs to retrieve Care Select Notification data.

For the following items: Complete all items for new Web pages. When changing an existing Web page, only provide information for the items that have changed and indicate N/A for unchanged items. Initiated By Clicking on the ‘Care Select Inquiry’ button.Page Mode InquiryPage Display Rules

CMO Search/Selection:CMO ID:Type of Service:

From Date:To Date:

Search button:

Reset button:

Export List button:

Reported Information:Date of Treatment:Type of Treatment:RID:Member’s Information:Signs, Symptoms, Dx:Facility’s Information:PMP’s Information:

Previous button:Next button:Export List button:

Page(s) it Calls

N/AUser Action Web Page Name Web Page Title Open in


New Window?


CMO Search/Selection:CMO ID: Display the valid 9-digit numeric to display.

Type of Service: Provide a drop-down list of the following: All Emergency Room Inpatient Care Outpatient Surgery

Default to ‘All’.

From Date: Allow standard date field. Date can be entered in mm/dd/yy or mm/dd/yyyy format with or without slashes. Valid date must be converted and displayed in mm/dd/yyyy format. Standard Date control is also available to populate the date. Required.

To Date: Allow standard date field. Date can be entered in mm/dd/yy or mm/dd/yyyy format with or without slashes. Valid date must be converted and displayed in mm/dd/yyyy format. Standard Date control is also available to populate the date. Required.

Search button: Clicking on the button will cause system to search for Care Select Notification information.

Reset button: Clicking on the button will remove entered data in the fields.

Export List button: Clicking on the button will export the data to .CSV file.

Reported Information:Date of Treatment: Display valid date of mm/dd/yyyy.Type of Service: Display member’s type of treatment. Emergency Room displays as ‘E’, Inpatient Care displays as ‘I’, and Outpatient Surgery displays as ‘O’.RID: Display 12-digit numeric.Member’s Information:

Name: Display member’s nameAddress: Display member’s home address.Phone: Display member’s phone.

Signs, Symptoms, Dx: Display member’s signs, symptoms or diagnosis.

Facility’s Information:Name: Display facility’s nameAddress: Display facility’s address.Phone: Display facility’s phone.NPI: Display facility’s NPI.

PMP’s Information:Name: Display PMP’s name.Phone: Display PMP’s phone.

Note:The Care Select Notification Inquiry page will display 25 notifications per


page.

Previous button: Clicking on this button will allow user to navigate to the previous page.Next button: Clicking on this button will allow user to navigate to the next page.Export List button: Clicking on this button will export the data to a .CSV file.


N/A

Page Security User must have CMO security access to Care Select Notification Inquiry in Web interChange.

Page Layout Care Select Notification InquiryCare Select Notification Inquiry

CMO Search /Selection

CMO ID:

From Date: To Date:

Search

Reported Information

Date of Treatment RID Member’s Information Signs, Symptoms, Dx Facility’s Information PMP’s Information

07/01/2009 999999999999 Doe, John950 N Meridian StIndianapolis , 46204317/222-2222

Headache New Hospital123 Main StIndianapolis , 46201317/555-5555NPI: 1234567890

Adam Smith317/333-3333

07/01/2009 888888888888 Doe, Jane950 N Meridian StIndianapolis , 46204317/222-2222

HeadacheBack pain

New Hospital123 Main StIndianapolis , 46201317/555-5555NPI: 1234567890

Adam Smith317/333-3333

Reset Export List

Previous Next

Service Type

E

E

Type of Service :


Window / Module Name: Window Title: Prerequisites:Data Flows:Ancestor Window: <Name of the Powerbuilder Ancestor window.>


Window Event: <Describe each window or data window event that extends or overrides the corresponding ancestor event.>

Specifications:


Report Definition: N/AReports - This section contains report information by subsystem. Types of reports include: form letters, online reports, and paper generated reports. Report layouts may be attached separately if necessary. Repeat Report chart for each report created or changed.

Access PWB, Publications for current reports and the Master Report Distribution List. Access the Master Report Definition Template by clicking on the link or in PWB, Publications, and Document Templates.

Submit documentation to Publications. The Master Report Distribution List will be updated by Publications from the information provided.


Report 1Report Title <Title of the report.>Report Code <List the seven or eight character name of the report. Optional> Report Function

<Briefly describe the business function of the report, how, and why it is used.>

External Report Description


For the following items: Complete all items for new reports. When changing an existing report, only provide information for the items that have changed and indicate N/A for unchanged items. Use the Master Report Definition Template from this link or from Project Workbook, Publications, Document Templates. Description of Information

<Briefly describe the information contained in the report.>

Purpose <Describe the reason to run the report.>

Distribution <Provide information for To, Media, Copies, and Frequency.>PHI Indicator <Yes or No> Detailed Field DefinitionsSort Sequence

<List the field name followed by a description of the field and valid values.

Totaling and Grouping

<Describe any grouping or totaling needed.>

Restore Priority

<Determine the OnDemand restore priority. Priority 1 – Very necessary to operations, Priority 2 - Necessary but information can be found another way, and Priority 3 – Not necessary>

Report Layout <Include or attach report layout here.>

Technical Design Section


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For Completion By the Technical Team OnlyWindow / Module Name: Window Title: Prerequisites:Data Flows:Ancestor Window: <Name of the Powerbuilder Ancestor window.>Window Event: <Describe each window or data window event that extends or



Interface/Extract Definition: N/AThis section contains interface/extract information. Types of interfaces/extracts include: data sets to vendors; data sets to customer; interfaces for vendors. Layouts may be attached separately if necessary. Repeat chart for each interface/extract created or changed.


Interface/Extract 1Extract Title <Title of the interface/extract>Extract Function

<Briefly describe the business function of the extract, how, and why it is used.>

External Extract Description


For the following items: Complete all items for new reports. When changing an existing report, only provide information for the items that have changed and indicate N/A for unchanged items. Use the Master Report Definition Template from this link or from Project Workbook, Publications, Document Templates. Description of Information

<Briefly describe the information contained in the extract.>

Purpose <Describe the reason to provide the extract.> Distribution <Provide information for To, Media, Copies, and Frequency.>PHI Indicator <Yes or No> Detailed Field Definitions

<List the field name followed by a description of the field and valid values.

Layout <Include or attach extract layout here.>





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Amendment HistoryLast Update Author Change Description

06/17/2009 Tiffany Tann Initial Creation (may be several iterations – all the work that is done prior to any reviews taking place)

06/24/2009 Tiffany Tann Update – Per external WSSR06/25/2009 Tiffany Tann Update – per Peggy Novotny e-mail


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