MITA Business Process Areas (Categories) and Processes

The Centers for Medicare and Medicaid Services (CMS) provides Federal Financial Participation (FFP) to fund significant portions of each state Mediciad Management Information System (MMIS) replacement initiative. Upon completion of an MMIS modernization effort, the ten Medicaid Information Technology Architecture (MITA) business process areas (in bold text) and the eighty individual business processes (numbered items) must be accounted for in the state's solutions.

Business Relationship Management (BR)

Standards Management

• BR01 Establish Business Relationship
• BR02 Manage Business Relationship Communication
• BR03 Manage Business Relationship Information
• BR04 Terminate Business Relationship

Care Management (CM)

Case Management

• CM01 Establish Case
• CM02 Manage Case Information
• CM03 Manage Population Health Outreach
• CM04 Manage Registry
• CM05 Perform Screening and Assessment
• CM06 Manage Treatment Plan and Outcomes

Authorization Determination

• CM07 Authorize Referral
• CM08 Authorize Service
• CM09 Authorize Treatment Plan

Contractor Management (CO)

Contractor Information Management

• CO01 Manage Contractor Information
• CO04 Inquire Contractor Information

Contractor Support

• CO02 Manage Contractor Communication
• CO03 Perform Contractor Outreach
• CO09 Manage Contractor Grievance and Appeal
• CO05 Produce Solicitation 
• CO06 Award Contract
• CO07 Manage Contract
• CO08 Close Out Contract

Eligibility and Enrollment Management (EE)

Member Enrollment (Future Release)

• EE01 Determine Member Eligibility (Under Development)
• EE02 Enroll Member (Under Development)
• EE03 Disenroll Member (Under Development)
• EE04 Inquire Member Eligibility (Under Development)

Provider Enrollment

• EE05 Determine Provider Eligibility
• EE06 Enroll Provider
• EE07 Disenroll Provider
• EE08 Inquire Provider Information

Financial Management (FM)

Accounts Receivable Management

• FM01 Manage Provider Recoupment
• FM02 Manage TPL Recovery
• FM03 Manage Estate Recovery
• FM04 Manage Drug Rebate
• FM05 Manage Cost Settlement
• FM06 Manage Accounts Receivable Information
• FM07 Manage Accounts Receivable Funds
• FM08 Prepare Member Premium Invoice

Accounts Payable Management

• FM09 Manage Contractor Payment
• FM10 Manage Member Financial Participation
• FM11 Manage Capitation Payment
• FM12 Manage Incentive Payment
• FM13 Manage Accounts Payable Information
• FM14 Manage Accounts Payable Disbursement
• FM15 Manage 1099

Fiscal Management

• FM16 Formulate Budget
• FM17 Manage Budget Information
• FM18 Manage Fund
• FM19 Generate Financial Report

Member Management (ME)

Member Information Management (Future Release)

• ME01 Manage Member Information (Under Development)

Member Support (Future Release)

• ME02 Manage Applicant and Member Communication (Under Development)
• ME08 Manage Member Grievance and Appeal (Under Development)
• ME03 Perform Population and Member Outreach (Under Development)

Operations Management (OM)

Payment and Reporting

• OM14 Generate Remittance Advice
• OM18 Inquire Payment Status
• OM27 Prepare Provider Payment
• OM28 Extract Information

Claims Adjudication

• OM07 Process Claims
• 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
• 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
• PL02 Maintain Program Policy
• PL03 Maintain State Plan

Health Plan Administration

• PL04 Manage Health Plan Information
• PL05 Manage Performance Measures

Health Benefits Administration

• PL06 Manage Health Benefit Information
• PL07 Manage Reference Information
• PL08 Manage Rate Setting

Provider Management (PM)

Provider Information Management

• PM01 Manage Provider Information
• PM08 Terminate Provider

Provider Support

• PM02 Manage Provider Communication
• PM07 Manage Provider Grievance and Appeal
• PM03 Perform Provider Outreach