Operations
Operations includes the day to day, transactional, business functions of the program. These are the core operational processes that directly support members, providers, and program compliance. The day to day, process driven, transactional work that keeps the program functioning. It includes the front line business functions that directly handle member, provider, and eligibility work flows.
Compliance (CO)
OP-CO-01 Grievance System Requirements
OP-CO-02 Material Changes to Business Operations and Provider Network
OP-CO-03 Subcontractor Delegated Oversight
Enrollment (TXIX)
OP-TXIX-01 Health Plan Disenrollments
OP-TXIX-02 Medicaid Eligibility Determinations
OP-TXIX-03 Members Residing Out of State
Member (ME)
OP-ME-01 Member Information Requirements
OP-ME-03 Resource Coordination
OP-ME-04 Member Rights and Responsibilities
