Draft_MSPP_Application_Appendix_B_Roles_and_Responsibilities_Matrix.xlsx
XLSX spreadsheet 13 KB Posted
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- Multi-State Plan Program Application
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- OPM35-12-R-0006
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Draft MSPP Application Appendix B
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Text version
Sheet1
| Function | Performed by | Using processes, procedures, and/or platforms that are | Comments/notes | ||||
| MSPP Issuer | State-level MSP Issuers | Subcontractor | Nationally standardized | Regionally standardized | Variable from State to State or State-level MSP Issuer to State-level MSP Issuer | ||
| (If MSPP Issuer is a group of issuers, identify which group member(s) performs the function) | (Use "A" if the entire function is performed by a subcontractor; use "S" if some of the function is performed by a subcontractor.) Note whether subcontractor is located or expected to perform work from a location outside of the U.S. | ||||||
| Enrollment (including acceptance, acknowledgement, and reconciliation of enrollments from Exchanges) | |||||||
| Premium collection and reconciliation (including receipt of advance payment of premium tax credits and cost sharing reduction payments) | |||||||
| Customer service | |||||||
| Marketing and outreach, including website, call center(s), advertising, and marketing material | |||||||
| Claims processing | |||||||
| Claims payment | |||||||
| Claims appeals | |||||||
| Quality assurance | |||||||
| Fraud and abuse prevention | |||||||
| Written communications to enrollees (including explanation of benefits forms, correspondence regarding claims, enrollment and premium correspondence) | |||||||
| Case management | |||||||
| Subcontractor oversight |
&"+,Bold"&13Appendix B: Roles and Responsibilities Matrix
&"+,Bold"&K04+000D R A F T MSPP Application September 2012
Sheet2
Sheet3
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