Translating Questions to Business Requirements
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Question
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Answer
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Business Requirement
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Message Content
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Why do I need a message?
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I need to meet a regulatory requirement
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CMS requires that we notify members that a member’s PCP can refer them to specialty care
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Your Primary Care Provider can refer you to a specialist for any specialty care needed.
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Why do I need a message?
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I need to communicate information
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Members need to know that providers with certain specialties may not be a PCP under their plan
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Providers with an Internal Medicine specialty are not PCPs under your plan.
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Why do I need a message?
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I need to direct the member to take action
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Members need to contact a vendor when searching for Urgent Care
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If you need to see a provider immediately, contact Urgent Care Provider at 800.123.4567 for an immediate consultation
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Building Out Your Business Requirements
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What is the Business Requirement?
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What Causes the Message to Appear?
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Does the Member Need to Take Action from the Message?
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Does the Message have Specific Characteristics?
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CMS requires that we notify members that a member’s PCP can refer them to specialty care
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The member performs a search for a PCP using the following search terms: “primary care”, “pcp”, ”primary care physician”
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No
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The message should display at the top of the search results screen for all searches, even if there are no results found
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Members need to know that providers with certain specialties may not be a PCP under their plan
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The member performs a search for a doctor with an internal medicine specialty, or a search for a PCP using the following search terms: “primary care”, “pcp”, ”primary care physician”
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No
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The message should display at the top of the search results screen for searches where providers are returned in the results; no message displays if there are no results
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Members need to contact a vendor when searching for Urgent Care
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The member searches for an urgent care provider using the search term “urgent care”
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Yes, the member needs to click the link that takes them to the Urgent Care vendor tool
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The message should display at the top of the search results screen for all searches, even if there are no results found
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