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PBH Local Business Plan 2007 <br />Gampalrison F~~H Waiver Tools; - df~~t NG Lh~~`a. ea ~ <br />° <br />Factor `' ~ - <br />~ -fix,,. ~ <br /> networks that are unmanaged <br /> Right to terminate providers <br /> from network. Control over quality and competency <br /> of individual providers. <br /> PBH ability to monitor both <br /> state and Medicaid Claims by Incentivizes Providers to work with <br /> provider is used to identify the LME <br /> provider billing patterns that <br /> require further evaluation or Oversight for Provider billing. <br /> technical assistance. <br />Business Direct enrollment of providers. State enrollment No delays in getting provider numbers <br />Operations: process; LME for staff. <br />(direct Weekly claims processing and endorsement only <br />enrollment of payment. PBH can adjust business processes <br />providers, and information system functionality <br />payment of In-house customized to address provider concerns. <br />claims, etc) Information System designed to <br /> support PBH managed care Improved cash flow for providers. <br /> functionality. Capable of <br /> expanding and continually Simplified billing system because no <br /> adjusting to changing provider interface with IPRS billing <br /> conditions. s stem. <br /> Integrated service management <br />Care Care coordination for both State services only across funding streams. <br />Coordination for Medicaid and state consumers. <br />State and Access to claims history allows LME to <br />Medicaid identify high cost consumers and <br /> intervene with the consumer and/or <br />services the provider to ensure access to the <br /> "right service in the right amount at <br /> the ri ht time". <br />Case PBH has retained case Provider based Case management activities can be <br />Management management for developmental more easily monitored and providers <br /> disabilities. requiring training or technical <br /> assistance can be more easily <br /> PBH has limited case identified. <br /> management (provided through <br /> community support) because PBH has a Community Support <br /> we have limited enrollment for Steering Committee with monthly <br /> Community Support to only meetings to provide technical <br /> three providers. assistance and to address problems in <br /> the implementation of the service <br /> PBH has clearly defined desired model. <br /> outcomes for Community <br /> Support that are regularly Because the number of providers is <br /> discussed with the designated limited, providers have enough <br /> providers. market share to support the <br /> necessary clinical infrastructure <br /> needed for effective service <br />~~ <br />