Operations Management (OM) Payment and Reporting OM14 Generate Remittance Advice Fiscal Management Community Alternatives OATS CHFS Security Officer Fiscal Management Provider Management OM18 Inquire Payment Status OM27 Prepare Provider Payment OM28 Manage Data Claims Adjudication OM07 Process Claims FA OATS Community Alternatives No Change OM29 Process Encounters OM20 Calculate Spend-Down Amount OM04 Submit Electronic Attachment OM05 Apply Mass Adjustment Performance Management (PE) Compliance Management PE01 Identify Utilization Anomalies RAC Program Integrity Program Quality and Outcomes FA OATS No Change PE02 Establish Compliance Incident PE03 Manage Compliance Incident Information PE04 Determine Adverse Action Incident PE05 Prepare REOMB Plan Management (PL) Plan Administration PL01 Develop Agency Goals and Objectives Commissioner’s Office Fiscal Management Policy and Operations Community Alternatives No Change PL02 Maintain Program Policy PL03 Maintain State Plan Health Plan Administration PL04 Manage Health Plan Information Commissioner’s Office Fiscal Management Policy and Operations Program Quality and Outcomes No Change PL05 Manage Performance Measures Health Benefits Administration PL06 Manage Health Benefit Information Commissioner’s Office Fiscal Management Policy and Operations Program Quality and Outcomes No Change PL07 Manage Reference Information PL08 Manage Rate Setting Provider Management (PM) Provider Information Management
How accurate are the results of the process? 5 5 Constraint: No planned enhancements How satisfied are the stakeholders? 2 4 Business Process Assessment 2 4 Table 34: Enroll Member Business Process 2.2.4.3 Disenroll Member The Disenroll Member business process is responsible for the termination of a member’s enrollment in a health plan or health benefit. An enrollment termination may occur due to: A member is no longer eligible based on redetermination of Medicaid eligibility either on an annual basis or as a result of change reporting during the coverage year. Upon receipt of a notification of incarceration, SMA may suspend eligibility (if State policy indicates to do so). A member is no longer eligible based on change in residence. The denial of eligibility for a benefit that is based on a technical factor or non- financial characteristic. A member submits a disenrollment request. Disenrollment request from a provider or contractor due to issues with the member such as moving out of service area, fraud and abuse, disruptive behavior, non-compliance, or death. Member is deceased. Receive disenrollment request from Manage Compliance Incident Information business process for continued failure to make payments. Receive disenrollment request from Determine Adverse Action Incident due to fraudulent or abuse activity. The provider or contactor has a change of status or termination that requires a mass disenrollment of members. A health plan or health benefit has a change that requires a mass disenrollment of members. A member modifies their MCO, PCCM, or waiver provider: Member changes information during Open Enrollment period. As permitted by State rules, such as the following: Change in member’s residence. A provider whom the member has chosen no longer contracts with current program or MCO. Medicaid terminates the contract with the member’s MCO or PCCM. Member successfully appeals auto-assignment. The member has issues with the MCO, PCCM, or waiver provider that may affect quality of care.
and Efficiency has been improved. Satisfaction with this process is improved for all stakeholders. Manage Provider Recoupment AS-IS Assessment TO-BE Assessment Note(s) Capability Question Is the process primarily manual or automatic? 2 3 What is the mode of communication? 2 3 How does the State Medicaid Agency requests recoupment of monies in third party liability situations requested? 3 3 Constraint: No planned enhancements. Medicaid B TPL rarely has provider recoupment. How integrated is the process? 2 2 Constraint: Technical limitation of system outside SMA. Does State Medicaid Agency use standards in the process? 3 3 Constraint: Technical limitation of system outside SMA. How timely is this end-to-end process? 1 2 How accurate is the information in the process? 2 3 How accessible is the information in the process? 3 3 Constraint: Technical limitations of system outside SMA. Regional exchange does not currently exist. What is the cost to perform the process compared to the benefits of the results? 3 3 Constraint: No further enhancements planned. How efficient is the process? 2 3 How accurate are the results of the process? 2 3 Does the business process satisfy stakeholders? 2 3 Business Process Assessment 1 2 Table 42: Manage Provider Recoupment Business Process 2.2.5.2 Manage TPL Recovery The Manage TPL Recovery business process begins by receiving TPL information from various sources such as external and internal information matches, tips, referrals, attorneys, compliance management incident, Medicaid Fraud Control Unit (MFCU), providers, and insurance companies. The business process: Identifies the provider or TPL carrier, locates recoverable claims. Creates the coordination of benefits file. Creates post-payment recovery files.
To-Be Kentucky Process Narrative: Add the ability to do targeted enhanced selection. Identify sample selection using enhanced sampling methodology. Retrieve sample selection data. Prepare the Explanation of Benefits and/or notification letters. Format data into the required data set. End: Send data to the Send Outbound Transaction for generation. Send data to Manage Applicant and Member Communication for tracking purposes. Prepare REOMB AS-IS Assessment TO-BE Assessment Note(s) Capability Question Is the process primarily manual or automatic? 3 3 Constraint: No planned enhancements. Does the State Medicaid Agency use standards in the process? 3 3 Constraint: No planned enhancements. If sampling is used, what sampling algorithm is used? 1 2 Is communication linguistically, culturally, and competency appropriate? 2 2 Constraint: No planned enhancements. How does the State Medicaid Agency collaborate with other agencies or entities in performing the process? 2 3 How timely is this end-to-end process? 3 3 Constraint: No planned enhancements. How accurate is the information in the process? 2 3 What is the cost to perform the process compared to the benefits of the results? 2 3 How efficient is the process? 2 3 How accurate are the results of the process? 2 3 Does the business process satisfy stakeholders? 2 3 Business Process Assessment 1 2 Table 81: Prepare REOMB Business Process 2.2.9 Plan Management (PL) The Plan Management business area includes the strategic planning, policymaking, monitoring, and oversight business processes of the agency. This business area is responsible for the primary data stores (e.g., Medicaid State Plan, health plans and health benefits) as well as performance measures, reference
Program information is distributed across multiple Program Information Repositories (KYMMIS, KHBE, MCOs, PBM) that receive requests to add, delete, or change data in program records. The Repositories validates data upload requests, apply instructions, and track activity. The Program Information Repositories provides access to payment records to other Business Area applications and users, especially those in Program Management and Program Integrity Management, via batch record transfers, response to queries, and “publish and subscribe” services. Currently, business users have direct and dynamic access to the Medicaid DW. DMS has adopted HIPAA standards. It has entered into memorandums of agreement to obtain data from other state agencies or to share data with them. Request from individuals in DMS or outside agencies pass through a common automated security process. The DW uses COTS products including Business Objects, Oracle and Economic and Social Research Institute (ESRI). State staff has been trained in the process, products and data to effectively use the Program Information. Also, state and vendor technical staffs are dedicated to assist or generate needed information. The data in the data warehouse has improved over time and the accuracy has steadily improved. The data warehouse is very accessible but there are occasional outages or special jobs that may limit availability. The stakeholders in the Program Information Business process are pleased with the utility of the process. To-Be Kentucky Process Narrative: In the future, there will be connectivity with Centers for Disease Control and Prevention (CDC), Vital Statistics, and Department of Juvenile Justice (DJJ), to gain additional data for data analytics. There will be continued training and sufficient licensing to connect additional DMS and other staff to increase access the DW and accessibility of data analytics. Manage Health Plan Information AS-IS Assessment TO-BE Assessment Capability Question Level Level Is the process primarily manual or automatic? 3 4 Does the State Medicaid Agency use standards in the process? 3 4 How does the State Medicaid Agency collaborate with other agencies or entities in performing the process? 3 4 How timely is this end-to-end process? 3 4 How accurate is the information in the process? 2 3 How accessible is the information in the process? 2 3 What is the cost of the process compared to the benefits of the results? 3 4 How efficient is the process? 2 3 How accurate are the results of the process? 3 4 Does the business process satisfy stakeholders? 3 4 Business Process Assessment 2 3
3.2 MITA Business Process Areas This section highlights the planned changes in the data architecture. Overall, the agency is consolidating data sources and realigning access channels and patterns to deliver a 21st century user experience. Data consolidation also helps with security by reducing the number of copies and making controls easier to apply. 3.2.1 Business Relationship Management Figure 19: Business Relationship Management Business Area Business Relationship Management Level 1 Level 2 Level 3 Level 4 Level 5 Note(s) Does the business area have governance of data management? As-Is To-Be Systems: KHBE Kentucky Medicaid Management Information System (KYMMIS) SharePoint for MCOs State Level Registry (Electronic Health Record (EHR) Incentive), electronic Management and Administrative Reporting System (eMARS) OATS has developed a data governance body to promote data standards and integrity throughout the State Medicaid Agency (SMA), but activity is
3.2.4 Eligibility and Enrollment Management Figure 25: Eligibility & Enrollment Management Business Area Eligibility and Enrollment Management Level 1 Level 2 Level 3 Level 4 Level 5 Note(s) Does the business area have governance of data management? As-Is To-Be Data governance exists on KHBE, KAMES, and SDX. There is a dichotomy between Member (automated) and Provider (manual) throughout for MITA maturity. OATS has developed a data governance body to promote data standards and integrity throughout the SMA, but activity is still in development and has not previously been focused on data governance from a MITA perspective. Does the business area have common data architecture? As-Is To-Be OATS relies on federal standards and details for contracted systems and can vary from project to project to manage data architecture. Standard procedures for the data models outlining how DMS/OATS defines data
Figure 33: Operations Management Data Store Changes To-Be Kentucky Medicaid is planning to implement a new MEMS in the near future. This will, of course, affect the operations management area considerably due to the fact that these processes are implemented in that system. The biggest set of changes to Operations Management will be the addition of a business rules engine to provide more flexible editing of claims and encounters. Encounter processing will see stricter editing and will be used to manage the MCO contracts in a more automated way. 3.2.8 Performance Management Figure 34: Performance Management Business Area Performance Management Level 1 Level 2 Level 3 Level 4 Level 5 Note(s) Does the business area have governance of data management? As-Is To-Be OATS has developed a data governance body to promote data standards and integrity throughout the SMA, but activity is still in development and has not previously been focused on data governance from a MITA perspective. Does the business area have common data architecture? As-Is To-Be Standards vary across system, common contractor layout across KYMMIS. OATS relies on federal standards and details for contracted systems and can vary from project to project to manage data architecture. Standard
No KPI Contractor Management (CO) Contract Management CO05 Produce Solicitation 2 3 Not aligned with MITA No use of shared business service tools or standards Limited workflow tools Standards needed for data exchange and interface Limited use of web based technologies No KPI Contractor Management (CO) Contract Management CO06 Award Contract 1 2 Limited use of web based technology and communications Limited use of web verification services Few workflow tools No KPI Contractor Management (CO) Contract Management CO07 Manage Contract 1 2 No business rules engine Limited workflow tools Standards needed for data exchange and interface Limited use of tracking to reduce duplicate services No KPI Contractor Management (CO) Contract Management CO08 Close Out Contract 2 3 No business rules engine Limited workflow tools Standards needed for data exchange and interface No KPI Eligibility & Enrollment Management (EE) Member Enrollment EE01 Determine Member Eligibility 3 4 No single portal for provider and member access No standard interface No business rules engine No KPI Eligibility & Enrollment Management (EE) Member Enrollment EE02 Enroll Member 2 4 No single portal for provider and member access No business rules engine Standards needed for data exchange and interface Limited use of web verification services
No KPI Eligibility & Enrollment Management (EE) Provider Enrollment EE07 Disenroll Provider 1 2 Currently a mix of manual steps and limited automation Partner Portal not fully implemented No automated decision making No business rules engine Limited workflow tools Standards needed for data exchange and interface Limited use of web verification services No KPI Eligibility & Enrollment Management (EE) Provider Enrollment EE08 Inquire Provider Information 1 2 Limited use of web based technology and communications Partner Portal not fully implemented No automated decision making No business rules engine Limited workflow tools Standards needed for data exchange and interface No KPI Financial Management (FM) Accounts Receivable Management FM01 Manage Provider Recoupment 1 2 No automated decision making No business rules engine Limited workflow tools Standards needed for data exchange and interface No KPI Financial Management (FM) Accounts Receivable Management FM02 Manage TPL Recovery 1 2 No automated decision making No business rules engine Limited interchange Limited workflow tools Standards needed for data exchange and interface No KPI Limited exchange of Third Party Liability (TPL) data with
other payers Financial Management (FM) Accounts Receivable Management FM03 Manage Estate Recovery 1 2 Process is manual No business rules engine Limited workflow tools Standards needed for data exchange and interface No KPI Financial Management (FM) Accounts Receivable Management FM04 Manage Drug Rebate 2 3 Limited integration between Decision Support System (DSS) and Pharmacy Benefits Manager (PBM) KPI set by contract Financial Management (FM) Accounts Receivable Management FM05 Manage Cost Settlement 1 2 Process is a mostly manual No business rules engine Limited workflow tools Standards needed for data exchange and interface No KPI Financial Management (FM) Accounts Receivable Management FM06 Manage Accounts Receivable Information 1 2 Process is a mix of manual and automated steps No business rules engine Limited workflow tools No KPI Financial Management (FM) Accounts Receivable Management FM07 Manage Accounts Receivable Funds 2 3 No business rules engine Limited workflow tools No KPI Financial Management (FM) Accounts Receivable Management FM08 Prepare Member Premium Invoice 1 2 Process is a mostly manual No business rules engine Limited workflow tools Standards needed for data exchange and interface No KPI
Financial Management (FM) Accounts Payable Management FM09 Manage Contractor Payment 2 2 No gap Financial Management (FM) Accounts Payable Management FM10 Manage Member Financial Participation 2 3 Data warehouse access is limited No business rules engine Limited workflow tools No KPI Financial Management (FM) Accounts Payable Management FM11 Manage Capitation Payment 2 2 No gap Financial Management (FM) Accounts Payable Management FM12 Manage Incentive Payment 2 3 Limited use of web based technologies and communications No automated decision making No business rules engine Limited workflow tools No KPI Financial Management (FM) Accounts Payable Management FM13 Manage Accounts Payable Information 2 2 No gap Financial Management (FM) Accounts Payable Management FM14 Manage Accounts Payable Disbursement 2 3 Higher maturity relies on system upgrades outside SMA (eMARS) No KPI Financial Management (FM) Accounts Payable Management FM15 Manage 1099 2 2 No gap Financial Management (FM) Fiscal Management FM16 Formulate Budget 2 3 Limited reporting capabilities for existing systems No predictive modeling capabilities Limited workflow tools
Plan Management (PL) Health Plan Administration PL05 Manage Performance Measures 2 3 No business rules engine Limited workflow and analytical tools Standards needed for data exchange and interface Access to data warehouse is limited Limited training No internal KPI Plan Management (PL) Health Benefits Administration PL06 Manage Health Benefit Information 2 3 Limited use of socio-economic and demographic data Access to data warehouse is limited Limited workflow and analytical tools No business rules engine No internal KPI Plan Management (PL) Health Benefits Administration PL07 Manage Reference Information 2 3 Access to data warehouse is limited Limited workflow and analytical tools No business rules engine No KPI Plan Management (PL) Health Benefits Administration PL08 Manage Rate Setting 2 3 No central repository for federal communications No business rules engine Limited workflow tools Standards needed for data exchange and interface Access to data warehouse is limited No KPI
Integration & Utility Logging 2 4 SMA has limited automation to high volume areas for onboarding. Integration & Utility Utility 2 3 SMA has no business rules engine Limited use of orchestration Limited use of composite applications Limited use of accessibility testing tools Plan Management Access & Delivery Client Support 1 2 No system currently in place Access & Delivery Business Intelligence 1 3 SMA business intelligence effort is not fully implemented SMA does not have enterprise wide performance metrics Access to data warehouse is limited Access & Delivery Forms & Reporting 1 2 SMA uses manual data entry and processing Access & Delivery Performance Measurement 1 2 SMA lacks enterprise performance standards Access & Delivery Security & Privacy 1 3 User authentication via SecureID tokens is limited by system Intermediary & Interface Business Process Management 2 3 MITA is not fully integrated SMA has no business rules engine SMA lacks enterprise modeling tools (using BPMN, BPEL, UML, etc.) Intermediary & Interface Relationship Management 2 3 MITA is not fully implemented No TPA tracking system other than claims submitters Intermediary & Interface Data Connectivity 2 4 No statewide information hub Information exchange is file based No library of exchange or interface formats. Intermediary & Interface Service Oriented Architecture (SOA) 2 4 No system currently in place Intermediary & Interface System Extensibility 2 4 REST and SOAP based web services are not integrated with intrastate agencies. Integration & Utility Configuration Management 1 2 No system currently in place Integration & Utility Data Access and Management 1 3 No system currently in place
Integration & Utility Logging 2 4 SMA has limited automation Integration & Utility Utility 1 3 SMA has no business rules engine No system currently in place Provider Management Access & Delivery Client Support 1 4 SMA lacks a single portal for provider and member access Access & Delivery Business Intelligence 3 5 SMA business intelligence effort is not fully implemented SMA does not have enterprise wide performance metrics Access to data warehouse is limited Access & Delivery Forms & Reporting 1 4 SMA uses manual data entry and processing Access & Delivery Performance Measurement 1 3 SMA lacks enterprise performance standards Access & Delivery Security & Privacy 1 4 User authentication via SecureID tokens is limited by system Intermediary & Interface Business Process Management 2 3 MITA is not fully integrated SMA has no business rules engine SMA lacks enterprise modeling tools (using BPMN, BPEL, UML, etc.) Intermediary & Interface Relationship Management 1 3 MITA is not fully implemented No TPA tracking system other than claims submitters Intermediary & Interface Data Connectivity 1 3 No statewide information hub Information exchange is file based No library of exchange or interface formats. Intermediary & Interface Service Oriented Architecture (SOA) 1 4 Not all systems are coordinated ESB usage is fragmented across the enterprise Intermediary & Interface System Extensibility 1 3 REST and SOAP based web services are not integrated with intrastate agencies. Integration & Utility Configuration Management 2 3 SMA uses a mix of manual and automated Configuration Management Integration & Utility Data Access and Management 1 3 Limited system currently in place SMA uses ad hoc formats for internal interfaces
across systems. Most systems today integrate using file passing techniques driven by extract programs that are set to run at specific times. The new strategy calls for data exchanges that are message based and are triggered by data change and business events rather than by a schedule. This will result in a reduction in latency of data flows reducing the time it takes to propagate changes across the enterprise from days to minutes. 7.4.2 Master Data Management MDM is the physical embodiment of DG. It includes tools to perform data quality analysis, probabilistic matching and sophisticated record merge and unmerge functions. It also includes the ability for automatic decision making by categorizing matches according to a weighted score so that thresholds can be applied for automatic versus guided actions. Systems can submit data and/or subscribe to data. Kentucky is using IBM’s MDM tool which houses the matching functions of an MDM program. The tool has the ability to match person or business demographics information based on complex algorithms and it even has the ability to match based on common misspellings and nicknames. For example, it knows that “Rob”, “Bob” and “Bobby” are all likely nicknames for “Robert”. The MDM tool also has the ability to support subscriptions from other systems via files or web services. Subscribing systems receive the golden record, but that record also contains all versions of any field that was different for the underlying records that were matched to produce the golden record. For example, suppose the following three records were matched: First Middle Last Address City State John Michael Smith 141 Dead Oak Ave Corbin KY John M Smith 141 Dead Oak Ave Corbin KY John Smith 141 Dead Oak Ave Corbin KY Table 129: Master Data Management The resulting record would be John (Michael or M or “”) Smith. The fields that were originally different contain multiple values. 7.4.3 Enterprise Data Flows The following diagrams depict the current and future state overall Kentucky Medicaid processing assets and data flows. Figure 53: Kentucky Medicaid Enterprise Architecture (Current State) Figure 54: Kentucky Medicaid Enterprise Architecture (Future State)
de-provision the MCAPS system. International Classification of Diseases (ICD)-10 May 2012 Oct 2015 $17,084,044 Remain compliant with regulatory requirements and compatible with trading partners Implement the ICD-10 code set Table 130: Kentucky Roadmap Defined Projects 7.4.6 MITA Enabler Projects Project Start Date End Date Cost Goals Objectives Transformed Medicaid Statistical Information System (T-MSIS) TBD TBD TBD Maintain Compliance Implement the T-MSIS requirements per CMS Implement All Payer Claims Database (APCD) TBD TBD TBD Improve health outcomes for all Kentuckians including past, present and future Medicaid recipients Enhance analytics efforts for Medicaid Contract to create the database Coordinate with other payers to submit data and establish rules of use Establish governing body Expand Analytics Scope TBD TBD TBD Improve input analysis to policy decisions Improve ability to validate policies that have been implemented Get finer resolution on the state of member health from groups to individual members in support of case Increase the sources of data being included in the analysis (APCD, DPH, KHIE, etc.) Increase the scope of the analysis being performed (clinical health, costs, quality, etc.)
management processes Establish a Formal Enterprise Data Governance Program ASAP Ongoing TBD Improve data quality Enhance data security Establish accountability for data from collection to final disposition Provide oversight for enterprise modeling efforts Establish a governing board Categorize data Identify owners Identify stewards Procure tools (KHBE already uses IBM’s MDM) Train technical staff Train data stewards Enterprise Modeling ASAP Ongoing TBD Enhance the ability to create, maintain and reuse effective business processes Enhance the ability to know what data is passed between actors Enhance the ability to leverage standards Enhance the ability to establish KPI Create business level artifacts that can be directly loaded into design and execution platforms Create a standards based modeling practice for process and data with properly trained staff and tools that support an enterprise approach Model all processes using the current BPMN standard to that they can be shared with other states in a standardized way. This will also result in models that can be automatically validated and communicate processes clearly and concisely.
report, analyze and display quality information (measures and KPIs) of all kinds. Including plan measures, clinical quality measures and KPIs that Medicaid defines for its own processes Business Process Automation and Key Performance Indicator (KPI) Project TBD TBD TBD Improve worker experience Improve client experience Reduce process execution time Enforce process execution for more consistency Produce process models in a standard format Identify and fully document in a standard language all major steps for all processes. Define KPIs for each step. Identify how each KPI will be collected and reported to the Quality Management System. Utilize workflow engine to automate process execution and KPI reporting to the QMS. Expansion of Workflow to unsupported processes TBD TBD TBD Automate administrative processes that are not currently supported by a system Ensure that business processes are defined and subsequently Leverage the KHBE workflow engine with or without existing SharePoint to automate business process execution and oversight. Create communications
followed Maintain maximum flexibility for business process changes bridge between workflow engine and QMS so that KPIs can be consolidated Electronic Clinical Quality Measures TBD TBD TBD Make it easier to get high quality clinical quality measure data from providers Use this data to manage for quality Use this data to support incentive programs Modify the Partner Portal to receive the electronic Clinical Quality Measures (eCQMs) for both level 1 and 3 Relocate the provider Graphical User Interface (GUI) to the Partner Portal Create an interface between the Partner Portal and the Electronic Health Record Incentive Program (EHRIP) system to pass compliance data Create and interface to the QMS to pass the measure data Formally funded and MITA Focused Enterprise Architecture Group TBD TBD TBD Establish MITA orientation for Medicaid architectures Help with KPI collection and analysis strategy Establish SOA standards Establish data Provide consistent modern technical architecture Provide procurement guidance, especially standards
standards and processes Appoint MITA business process champions who will work to improve MITA alignment and maturity boilerplate, RFP validation, and selection Interoperability Project TBD TBD TBD Improve interface management capabilities Reduce latency of data flows Improve use of standards in exchanges Document all exchanges in detail Create tracking system for BRM functions Define areas of improvement for interfaces Define an implementation plan Conduct Leveraged Systems Assessment TBD TBD TBD Determine the best strategy for reusing existing Medicaid systems assets Conduct a comprehensive assessment of current assets Evaluate the reusability of those assets Publish a plan for performing any remediation necessary to bring existing system assets up to reusable status Table 131: MITA Enabler Projects
MMIS Medicaid Management Information System MMM MITA Maturity Model MOA Memorandum of Agreement MOU Memorandum of Understanding MU Meaningful Use MWMA Medicaid Wavier Management Application NAICS North American Industry Classification System NCCI National Correct Coding Initiative NCPDP National Council for Prescription Drug Programs NDC National Drug Code NEMT Non-Emergency Medical Transportation NF Nursing Facility NLR National Level Registry NPDB National Practitioner Database NPI National Provider Identifier NPPES National Plan & Provider Enumeration System NTE Notes OATS Office of Administrative and Technology Services OIG Office of the Inspector General OKHBE Office of Kentucky Health Benefits Exchange OLS Office of Legal Services OM Operations Management OPM Office of Personnel Management OPS Office of Procurement Services PAFS-78 Request for Hearing, Appeal or Withdrawal (Dept. for Community Based Service - KY) PASRR Pre-Admission Screening and Resident Review PBM Pharmacy Benefits Manager PCCM Primary Care Case Management PCP Primary Care Physician PE Performance Management PG Program Management PHR Personal Health Record PI Program Integrity PL Plan Management PM Provider Management PMP Preferred Medical Plan PMPM Per Member - Per Month POS Point of Sale
TANF Temporary Assistance for Needy Families TIN Tax Identification Number TMA Transitional Medical Assistance TMSIS Transformed Medicaid Statistical Information System TPA Trading Partner Agreement TPL Third Party Liability UK University of Kentucky UPD Universal Provider Datasource USPS United States Postal Service VSS Vendor Self Service XML Extensible Markup Language XSD XML Schema Definition