1. Project InitiationForm
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Project Name : HSIS
Milliman Cite Auto Auth
Submitted by:
Alecia Chrin
Request Date:
05/03/2012
Executive Sponsor:
Janet Tomcavage
Business Owner:
HSIS (Vicki Harter)/ MM (Bret
Yarczower)
IT Lead:
James Cibak
Problem Statement:
Utilization review(UR) for medical necessity authorization isonecornerstone of comprehensive medical costmanagement, but
requires a largeinvestment in clerical and clinical FTE’s for data entry, handling requests for additional information and criteria
based review. GHP’s recent and future growth in membership necessitates a timely and cost-effective solution to control the
growing administrativeburden, whileseeking strategic alternatives to addingstaff and head count. In addition,becauseUR is a
significantcomponent in managingMedicaid medical expense, the demand on UM nurses and clerical staff is expected to increas e
with the additional members added through the state award.
Further, provider satisfaction surveys haveidentified a need for electronic interfaces for submission of requests, more transparent
availability of evidence-based criteria and most importantly, more efficientreview and response to requests for authorization.
Finally,PPACArequirements continue to pointto enhanced electronic interfaces between providers and Plans.
Background:
RadMD, a similar butunrelated on-linesubmission and responsesystem for non-emergent outpatient radiology services,has been
increasingly adopted by GHP providers who seek a more streamlined and transparentprocess.For non-radiology requests, GHS
adoption of this auto-authorization process would create significantefficiencies for both GHS and GHP, and has been a repeated
request by business officeleadership.
The Milliman solution also providers out-of-the-box integration capabilities with in-housedeveloped software applications(e.g.
current Plan website) and various vendor software packages. Most notably, Milliman has experienceintegr atingthe auto auth
functionality with Navinet to allowfor a singular provider facing/ portal,whileleveragingthe core Milliman requestsubmission,
guidelines and auto adjudication functionality which Navinetdoes not provide.
Non-IT Solutions:
Reducing the scope and volume of UR requests has been an active,ongoing process.Thus far, trimming the prior auth listthis has
not reduced FTE requirements. In addition,analysisof items removed from prior auth requirements based on few denials (such as
non-urgent ambulance) have led to significantgrowth in medical expense. Similarly,GOLD cardingwithout notification and
monitoringbears significantrisk to the Plan.
Project Description:
Milliman Auto Authorization is a software tool – typically accessed through a web portal – that offers real-time, self-serviceaccess
to member eligibility and medical necessity authorization.Itcreates administrativeefficiencies for both payors and providers.The
Web-based interface, provided through a payor's portal,makes it easy for a provider to document and supporttreatment requests.
By attachingthe relevant guidelinecontent to the request and sendingit directly to the payor,providers receive an expedited,
often immediate, response. Cite AutoAuth Module matches the payor's specific criteriato the clinical information and attached
guidelinecontent to automatically authorizethe procedure or admission.
Deliverables:
 Complete IT contractaddendum to add Cite Auto Auth
 Business development of an operating plan to identify level of automation at a request type or provider level
 Development of a plan to map, create and develop operational processes,based on recommendations and guidanceof
Medical Directors and MM leadership
 Develop and conduct UAT plan followingSDLC standards
 Trainingplan for roll outand operational readiness
 Technical specificationsfor softwareinstallation
 Documented operational supportrequirements and plan

2. Project InitiationForm
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 Creation of a project scheduleto support required tasks and activities required for all implementation tasks
Risks:
 Data and technology infrastructurereview based on current platform
 Availability of business unitresources to plan level of automation at a criteria and/or provider level for implementation by
HSIS personnel
Assumptions:
 Current Milliman server is adequateto support this additional module
 Business and technical resources will beavailable
 There is no redundancy with existingor planned software systems
 Maintenance and reporting will beavailablethrough HSIS
 Vendor application will scaleand perform based on specifications
 Provider participation and satisfaction will besignificantly enhanced
Architecture
Considerations
<Work with the Architecture Review Board (ARB), currently chaired by DavidStrzempek <dwstrzempek@geisinger.edu>,
to review this PIF prior to presenting to the ITSC. Include ARB findings here when completed.>
Proposed
Solution
Investment
Effort in Hours: Business: ~160 hours IT: ~200 hours
Duration in Weeks: 8 week
Expected Completion Date: July 16, 2012
Expected Cost: ~$17,500 – 20,000 (includes provision for vendor consulting fees, if needed)
Overall Project
Investment
Potential Benefits: (To be refined during Concept Exploration)
Anticipated organizational and financial impactto the business include:
 2 GHP FTE MM / UM clerical supportsaved based on request entry by requestor would reduce clerical
salary dollarsby ~$32,000.
 A modest assumption of 10,000 requests handled automatically,year one would save ~$92,000 in
salary dollars. 15,000 requests could resultin year one savings of ~$140,000
o Future savings Increases will beproportional to the year-over-year growth in membership.
 Time and cost savings arealso similarly anticipated for Pharmacy – to be quantified the development
of the project solution.
Financial:
Year one software costs will be~$125,000 - $150,000. Resource implementation costs areanticipated to be
~$50,000 - $75,000. Contracted resource needs will be evaluated duringthe projectsolution phase.
Non-Financial:
The benefits to GHP will be realized as a resultof increased provider satisfaction whilemaintainingURcontrols;
reduced administrativecosts for UR through streamlined departmental work flow; Increased ability for MM
clinical staff to focus on high costpopulations;increased firstpasses with complete data thereby reducing
turnaround time; improved clinical controlsand quality;and smooth integration with existingsoftware.
Effort in Hours: Business: 360hours IT: 480 hours
Duration in Weeks: 16 - 20
Potential Completion Date: Nov 26, 2012
Potential Cost: ~$200,000 (year one)
Estimate Accuracy Tolerance: (+/- percent) 30%
Budgeted:
X No Yes Budget Amount $0.00
(This was not budgeted for FY’12. The project has been allocated for in the FY’13 budget)
Project Impact: <What areas of the company or systems are likely to be touched by the proposed solution?>
 PNM: Increased provider satisfaction
 Pharmacy: e-submission or e-reviews potential

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Project Size: <Using the Project SizingTool, Provide very high level project sizingestimate for business and IT
Small <120; Medium=120-500; Large=501-1000; J1=1001-4000; J2=4001-7000; J3 >7000>
Business: Small Med X Large J1 J2 J3
IT: Small Med X Large J1 J2 J3
Impact to
Planned or
Active IT Work:
<Describe the impact to in- queue, scheduled or active IT engagements (projects or SRs).>
The project solution phaseis notanticipated to have any impacton current projects. Assumingexisting
demand levels,production supportfor Milliman or other applicationsis similarly anticipated to be unaffected
by this effort.
Alignment with plans for Navinet implementation will becoordinated as partof the projectsolution phase.
An impactassessmentwill becompleted for the construction phaseas partof the project solution
documentation submission.
Next Steps <Describe the next steps.>
Detailed analysis and documentation of the following:
 Functional requirements, work flows and use cases for auto auth processing –includingprocesses for
UM and Pharmacy
 Technical specificationsfor implementation of the new software components
 Testing requirements for new software functionality
 Trainingand operational readinessactivities required for go-live
 Schedule tasks necessary for implementation
Resources
Required for
Next Steps:
HSIS project staff are accountable for the Milliman system implementation and maintenance. This work is planned
extension of that activity and aligns with the parallel request to map authorization outcomes to Amsysis.
Role* Name
Project Manager Alecia Chrin
BSA TBD
SMEs HSIS: Gail Klinger
Technical Lead Les Wetzel
Infrastructure TBD
<*Must minimally include the Project Manager, Business Systems Analyst, Subject Matter Experts (SMEs) and the
Technical Lead. “TBD”is acceptable for planned resources. >
Approval:
Executive Sponsor
Date:
5/21/2012
Business Owner
Date:
5/21/2012
IT Lead
Date:
5/21/2012
IT Steering Committee: X Yes No
Date
5/21/2012

4. Project InitiationForm
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<Instructions on how to use this template>
<All of the instructions on how to use this template are provided in italic text, and preceded and ended by “<” and “>” symbols. All instructions are to
be removed and replaced with the appropriate information in the correct font and color. When possible, document properties have been inserted to
facilitate the replacement of common terms or names. The business owner is encouraged to complete areas of the template shaded with a yellow
background (e.g Business Problem)>.
1. Project Name: Project Name as definedbythe Executive Sponsor and/or BusinessOwner.
2. Submitted by: Individualcompleting the request.
3. Request Date: Date of the request.
4. Executive Sponsor: Champions a project to executive management, endorsesthe project goals, andprovides highlevel project guidance.
5. Business Owner: Member of the senior management teamon the business side that has ultimate accountabilityfor the success, schedule
and budget ofthe project.
6. IT Lead: Member of the IT senior management teamandhas ultimate accountabilityfor the success, schedule andbudget ofthe project
from an IT perspective.
7. Problem Statement: Statement describing the businessopportunityinbusiness terms.
8. Non-IT Solutions: Statement describingthe alternative non-ITbusiness solutions.
9. Project Description: Describes the scope of the project.
a. Deliverables:Describesthe specific project deliverables.
10. Architecture Considerations: Include the Architecture Review Boards finding. To obtainfinding schedule a review withthe ARB
through the ARB chair, current chair is David W. Strzempek <dwstrzempek@geisinger.edu>.
11. Proposed Solution Investment: This part of the Project Initiationdocument focuseson what is requiredto complete the Project
Definitionphase (sometimes calledConcept Exploration). Enter the Total Effort inHours as well as break it downbyBusiness and IT. Then
Enter the expectedduration inWeeks alongwith the ExpectedCompletion Date ofthe Phase. This wouldbe the date that you are able to
bring it back to the ITSCwitha complete justificationetc. Finally, identifythe expected cost of this phase.
12. Overall Project Investment: This sectionwill be refined during Concept Exploration but is required for approval of the initial phase. The
actual ROI willbe documentedusing the ITSpendingTemplate after allis knownfrom the CE.
a. .Financial: Once againenter the same data as above but for the entire project. These will be totalestimates and will be refined
during the CE. The actual ROI will be calculatedanddocumentedin the ITSpendingTemplate.
b. Non-Financial: Describe non-financialbenefits. Examples include an increase in customer satisfactionbyX, quality
improvement byY, etc
c. Estimate Accuracy Tolerance: :Enter the percent accuracyyou believe your estimates are.
13. Budgeted: Is the project budgeted(Y/N) and budget amount.
14. Project Impact: Areas of the companyor systems are likelyto be touchedbythe proposed solution.
15. Project Size: Provide a project size estimate from the business andITperspective, usingthe Project Sizing Tool.
16. Impact to active IT work: Describe the current IT workthat will be affectedbythis request.
17. Next Steps: With a request approval, describe the next steps.
18. Resources Required for Next Steps: Describe whois assignedto the engagement. At a minimum, include the Project Manager, Business
Systems Analyst, Subject Matter Experts (SMEs) and Technical Lead.
19. Approval: Obtainapproval bythe designated management teammembers.
20. IT Steering Committee: ITSCrequest approval and date.