MITA Glossary of Terms

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MI T A G l o s s a r y o f T e r m s f o r R e v i e w C o m p i l e d 2 0 0 9 b y
P O G I S


MITA Glossary of Terms

Posted for
comment and
r
eview

04/14/2009

Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

As Is state

Current state of business operations or technology.


CMS MITA
2.0
Framework




Business Area

A high level
grouping of business processes that share
common focus and information. (MITA)

BA

CMS MITA
2.0
Framework




Business
Capability

A specific level of maturity of a business process.


CMS MITA
2.0
Framework




Business
Capability
Matrix

Defines the
maturation characteristics for individual
business processes. The Business Capability Matrix aligns
with the Maturity Model. Applying the maturity model to
each business process yields the Business Capability
Matrix, which shows how business process matu
res over
time.

BCM

CMS MITA
2.0
Framework




Business P
rocess

A collection of related, structured activities
--
a chain of
events
--
that produce a specific service or product for a
particular customer or customers.


An activity begun with a unique trigger
event and
producing specific result.


Interoperabi
lity
Clearinghou
se Glossary
of Terms
(http://ww
w.ichnet.org
/glossary.ht
m)

GAO

CMS


Business Process
Steps

A sequence of steps that execute the successful
completion of the business process (steps start wit
h a
verb)


CMS MITA
2.0
Framework




Business
Relationship
The Business Relationship Management business area is
currently represented in many States as a component of
BR

CMS MITA
2.0



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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

Management
Business Area

Program Management. It is shown here as a separate
business
area because collaboration between in
-
State
agencies and inter
-
State and Federal agencies is
increasing in importance.

This business area owns the standards for interoperability
between the agency and its partners. It contains business
processes that have

a common purpose (e.g., establish
the interagency service agreement, identify the types of
information to be exchanged, identify security and privacy
requirements, define communication protocol, and
oversee the transfer of information.)

Fr
amework

Capability

A capability is the ability and the capacity to perform a set
of tasks.


CMS MITA
2.0
Framework

Canadian
National
Defense



Care
Management

Business Area

The Care Management business area illustrates the
growing importance of care management as the Medicaid
program evolves. Care Management collects information
about the needs of the individual member, plan of
treatment, targeted outcomes, and the individua
l’s health
status. It also contains business processes that have a
common purpose (e.g., identify clients with special needs,
assess needs, develop treatment plan, monitor and
manage the plan, and report outcomes). This business
area includes processes t
hat support individual care
management and population management.

CM

CMS MITA
2.0
Framework




Concept of
Operations

A tool used to describe current business operations and
to envision a future transformation that meets the needs
of stakeholders and res
ponds to enablers (e.g., new
policy, legislation, and

technology).


CMS MITA
2.0
Framework




Constraints

Conditions that must be met for this generalized process
to execute (e.g., enrolling institutional providers requires
different information from
enrolling pharmacies)


CMS MITA
2.0
Framework




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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

Contractor
Management
Business Area

The Contractor Management business area
accommodates States that have managed care contracts
or a variety of outsourced contracts. Some States may,
for example, group
Provider and Contractor in one
business area. The Contractor Management business
area has a common focus (e.g., manage outsourced
contracts), owns and uses a specific set of data (e.g.,
information about the contractor or the contract), and
uses business
processes that have a common purpose
(e.g., solicitation, procurement, award, monitoring,
management, and closeout of a variety of contract types).

CO

CMS MITA
2.0
Framework




Cost
Effectiveness

Ratio of the amount of effort and cost to outcome


CMS MITA

2.0
Framework




Data Accuracy
and Accessibility

Ease of access to data that the business process requires
and the timeliness and accuracy of data used by the
business process.


CMS MITA
2.0
Framework




Detailed System
Design

A Detailed System Design (DSD) document describes how
the system will function, the data to be maintained, and
the procedures to be put in place.

DSD

CMS MITA
2.0
Framework




Efficiency; Ease
of Performance

Level of effort necessary to perform the busi
ness process
given current resources.


CMS MITA
2.0
Framework




Failures

An identification of the exit points throughout the
business process where the Business Logic specifies that
the process must terminate because of failure of one or
more steps


CMS
MITA
2.0
Framework




Information
Architecture

The MITA Information Architecture describes a logical
architecture for the Medicaid enterprise. It provides a
description of the information strategy, architecture, and
data to a sufficient level that it may

be used to define the
data needs that will enable the future business processes
of their Medicaid enterprise.


CMS MITA
2.0
Framework

MN Dept of
Human
Services



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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

Master Patient
Index

An index of patients, persons, members of healthcare
plans, guarantors, physicians, healthcare practitioners,
payers, employees, employers, or others. It may also be
called an enterprise master patient index (EMPI),
enterprise patient index (EPI), corpora
te person index
(CPI), or another similar description. MPIs shared by two
or more care centers may be considered an "enterprise,"
"corporate" or "multi
-
facility" MPI.

MPI/eMPI

AHIMA

CMS



Medicaids

State Medicaid Agencies.


CMS MITA
2.0
Framework




Member
Management

Business Area

The Member Management business area is a collection of
business processes involved in communications between
the Medicaid agency and the prospective or enrolled
beneficiary and actions that the agency takes on behalf of
the
beneficiary. These processes share a common set of
beneficiary
-
related data. The goal for this business area is
to improve healthcare outcomes and raise the level of
consumer satisfaction.

ME

CMS MITA
2.0
Framework




MITA business
and technical
services

Provide a standard set of operations with a standard
interface for all business processes.


CMS MITA
2.0
Framework




MITA Standard
Interfaces

MITA uses the same methodology to define MITA services
as the industry has used to define Web services.

The
interface to all services will be defined using WSDL, and
all messages and data will be defined in XML. This does
not indicate that all MITA services are available as Web
services, only that their interfaces are defined using the
same mechanisms as
Web services. The business services
define the business processes that must be exposed and
defines their standard interfaces.


CMS MITA
2.0
Framework




Operations
Management
Business Area

The Operations Management business area is the focal
point of
most State Medicaid enterprises today
.
It
includes operations that support the payment of
OM

CMS MITA
2.0
Framework




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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

providers, managed care organizations, other agencies,
insurers, and Medicare premiums and support the receipt
of payments from other insurers, providers, and member

premiums.

This business area focuses on payments and receivables
and “owns” all information associated with service
payment and receivables. Most States have automated
operations that support these payments. In fact, this is
probably the part of Medica
id that is most representative
of all State

Medicaid programs. Common business processes include
validating requests for payment and determining payable
amount; responding to premium payment schedules and
determining payable amount; and identifying and
pur
suing recoveries.

Performance
Measures

Measures that describe what can be measured but that
are not specific measures in themselves


CMS MITA
2.0
Framework




Predecessor

The preceding business process, the Result of which
becomes an input Trigger to this business process


CMS MITA
2.0
Framework




Program
Integrity
Management

Business Area

The Care Management business area illustrates the
growing importance of care management as the Medicaid
program evolves. Care
Management collects information
about the needs of the individual member, plan of
treatment, targeted outcomes, and the individual’s health
status. It also contains business processes that have a
common purpose (e.g., identify clients with special needs,
assess needs, develop treatment plan, monitor and
manage the plan, and report outcomes).


This business area includes processes that support
individual care management and population
management. Population management targets groups of
PI

CMS MITA
2.0
Framework




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P O G I S


Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

individuals with sim
ilar characteristics and needs and
promotes health education and awareness.

Program
Management
Business Area

The Program Management business area houses the
strategic planning, policy making, monitoring, and
oversight
activities of the agency. These activities depend
heavily on access to timely and accurate data and the use
of analytical tools. This business area uses a specific set
of data (e.g., information about the benefit plans covered,
services rendered, expendi
tures, performance outcomes,
and goals and objectives) and contains business processes
that have a common purpose (e.g., managing the
Medicaid program to achieve the agency’s goals and

o
bjectives

such as by meeting budget objectives,
improving customer sat
isfaction, and improving quality
and health outcomes).

PG

CMS MITA
2.0
Framework




Provider
Management

Business Area

The Provider Management business area is a collection of
business processes that focus on recruiting potential
providers, supporting the

needs of the population,
maintaining information on the provider, and
communicating with the provider community. The goal of
this business area is to maintain a robust provider
network that meets the

needs of both beneficiaries and
provider

communities a
nd allows the State Medicaid
agency to monitor and

reward provider performance

and
improve healthcare outcomes.


PM

CMS MITA
2.0
Framework




Quality of
Process Results

Demonstrable benefits from using the business process


CMS MITA
2.0
Framework




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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

Registry

Recognized service directory. A registry stores
information about services in an SOA. At a minimum, the
registry includes information that other participants can
look up to find out the location of the service and what it
does (the UDDI specific
ation defines a web services
standard for this functionality). A registry may also
include information about policies that are applied to the
service, such as security requirements, quality of service
commitments and billing. Some registries are extended

with document repositories, providing more detailed
information about the operation and constraints of the
service that may be useful to developers, administrators,
or users.


CMS MITA
2.0
Framework

Loosely
Coupled



Result

One or more outcomes from
the execution of the
Business Logic (results are defined as data in motion and
are the immediate output from the business process, not
the ultimate,

downstream result) The Result is a defined data set.


CMS MITA
2.0
Framework




State
Self
-
Assessment

A State’s identification of current and future level of
business capability for each business process. Recognized
service directory.

A
sks States to compare current
business operations, technical capabilities, and targeted
levels of improvement to models
supplied in the
Framework document; e.g., Business and Technical
Capability Matrixes.

SS
-
A

CMS MITA
2.0
Framework




Shared Data

Shared data is data at rest (i.e., data stores accessed to
complete a step in the business process) Shared data is a
defined
data set.


CMS MITA
2.0
Framework




Sub Business
Area

A lower level grouping of business processes (for more
complex Business Areas)


CMS MITA
2.0



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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

Framework

Successor

The Results of this business process, which may become a
Trigger for another
business process


CMS MITA
2.0
Framework




System
Integration
Testing

System testing is conducted by the vendor, using the test
cases prepared to ensure the system functions properly.

SIT

CMS MITA
2.0
Framework




Technical
Architecture

The MITA technical architecture includes:

Data architecture

Application architecture

Technology architecture


Collectively, they define a set of technical services and
standards that a can be used to plan and specify future
systems. These standards in
clude:

The adoption and use of common (industry and MMIS)
standards

Identification of common vs. state specific processes, data
and technical solutions

Business Driven Design of MMIS processes

Built in security and delivery of data

Scalability, interopera
bility and extendibility of MMIS
components

Performance metrics common to the various MMIS
operations

TA

CMS MITA
2.0
Framework

MN Dept of
Human
Service



Timeliness of
Business Process

Time lapse between the agency’s initiation of a
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CMS MITA
2.0
Framework




To Be state

Future state of business operations or
technology


CMS MITA
2.0
Framework




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Term

Generic Definition

Acronym

Source

Source 2

Source 3

Source 4

Trigger

An occurrence that triggers a business process (e.g.,
receipt of a request, phone call, or a scheduled date)
The Trigger is a defined data set.


CMS MITA
2.0
Framework




Utility or Value
to Stakeholders

Impact of the business process on individual
beneficiaries, providers, and Medicaid staff


CMS MITA
2.0
Framework




Web Service
Definition
Language

"An XML format for describing network services as a
set of endpoints operating on messages containing
either document
-
oriented or procedure
-
oriented
information. The operations and messages are
described abstractly, and then bound to a concrete
network protocol and message format to define an
endpoint. Related concrete endpoints are combined
into abstract
endpoints (services). WSDL is
extensible to allow description of endpoints and
their messages regardless of what message formats
or network protocols are used to communicate,
however, the only bindings described in this
document describe how to use WSDL in

conjunction
with SOAP 1.1, HTTP GET/POST, and MIME.

WSDL

W3C