NO

TYPE 1 PROCESS

ACTIVITY File Generation-Process

2 PROCESS

Update CMS Response tables Risk Member Detail and Risk Summary Process

3 PROCESS

4 GWT SCREEN 5 GWT SCREEN

RAPS Processor and Quick RAPS Scorecards Rulesets Configuration

6 PROCESS

Improvement Algorithms-Process

7 GWT SCREEN

HCC Imprvement Scorecards

8 GWT SCREEN

Risk member and Risk Summary Screens

9 GWT SCREEN 10 REPORTS

RAPS and RISk Queue Reports:RAPS and HCC Improvement Reports

TASK DESCRIPTION Generating the CMS RAPS file for 20 members (Generates the file for Quick RAPS data too).Program run at command line To update the CMS report tables(Feras Response ,RAPS Transaction Reports, RAPS Summary Reports , MOR and MMR Reports).We have tried to simulate the CMS reports but need to dynamically update the spreadsheet with the file id generated from the previous step.Once the spreadsheets are updated the program will run at command line to restore the reports to DB This program run at command line will update the risk member detail and summary for all members based on the MOR data processed in step 2 All the RAPS scorecards with member level detail and Quick RAPS Scorecard is available for viewing.Will reflect the new files that have been generated.Hierarchy option is also available to filter members based on a diferent LOB Ruleset has already been configured.View or modify the ruleset and the filters and suspects and Fall-off algorithms. The program for Improvement algorithm runs for the rulesets created.Backend process runs at command line picking up active rulestes available. The HCC Improvement Scorecards are available for viewing.The top 10 HCC's,RxHCC's ,ICD9's and Fall-off data reflects data that was run for the 20 members.Hierarchy is available for filtering members . Go to the Member Tab and view the risk detail and summary detail for specific members.Reflects all their current HCC's, RxHCC's , the relevant diagnosis and risk scores. The raps transaction errors and the algorith results get stored in the queues and is available for viewing.Click on an item and the queue detail can be viewed All reports deployed and viewable and will reflect all changes made from step 1 to 9

ENTRY CRITERIA The source tables

EXIT A flat file for CMS is generated

Simulated reports that have to be updated with fileid from step 1 CMS reports gets restored to Database The process gets executed and risk member detail and risk summery gets updated at the Step 2 Completed backend

Step 2 Completed GWT UI for Creating or modifying the rulesets

Scorecards Viewed Rulesets created for Improvement algorithms

Rulesets creation

Completion of the program

Step 6 Completion

Scorecard viewed to reflect changes

Step 3 Completion Step 2 and Step 6 Completed Steps 1-9 completed

Member tab updated with current risk details

Queue Screens viewable Reports viewable