Global Concepts
What is Robotics Processing Automation?
Robotic process automation (RPA) is the use of software automation to perform high-volume, repetitive, labor-intensive online tasks that previously required humans to perform. RPA involves robotic rules-based decision making to simulate human interaction with digital systems and software.
RPA is also commonly known as the use of bots.
Is it considered RPA if a human being enters all the information into the Provider Online Service Center (POSC) directly to execute a transaction?
No. If a human being data enters information directly into the POSC to execute a transaction that is not considered RPA.
What is MassHealth's policy regarding the use of RPA technology?
MassHealth understands that using RPA can reduce the administrative burden and streamline manual processes. This can help organizations gain operational efficiencies.
Effective July 1, 2022, MassHealth will allow organizations (providers, relationship entities and business partners) to use RPA technology on the POSC. Organizations must submit a registration request to MassHealth and receive official approval before using bots on the POSC.
Please refer to the MassHealth RPA Policy found at www.mass.gov/rpapolicy.
How is RPA used on the POSC?
Organizations may use RPA on the POSC to perform transactions such as checking member eligibility, submitting claims, and other Direct Data Entry (DDE) activities.
Is there a specific RPA tool that should be used on the POSC?
No. MassHealth has not defined any specific RPA tools that can or cannot be used on the POSC at this time.
How can I learn more about MassHealth's policy to use RPA technology on the POSC?
Please refer to the MassHealth RPA Policy and supporting documentation found at www.mass.gov/rpapolicy. The information includes instructions on how to register your bot with MassHealth and the necessary requirements.
RPA Registration Request and Approval Process
On or after July 1, 2022, how do I request approval to implement a bot on the POSC?
Organizations must first complete and submit the MassHealth RPA Stage I Registration Form. Once approved by MassHealth, a Stage I approval number will be issued.
Once an organization has completed testing of the bot, the organization must submit the MassHealth RPA Stage II Registration Form to MassHealth for evaluation and approval with all the supporting documentation. The Stage I approval number issued by MassHealth must also be referenced in the MassHealth RPA Stage II Registration Form. Once MassHealth completes the evaluation, it will notify the organization of the disposition.
Once the Stage II registration request is approved, MassHealth will assign official RPA User IDs that each organization must create and assign to the bot before using it on the POSC. All registration request forms can be found at www.mass.gov/rpapolicy.
What supporting documentation do organizations have to include with the Stage II Registration Form?
Organizations must submit the following documentation along with the Stage II requests:
1) Signed MassHealth RPA Agreement.
2) Systems Design Documentation, which must include
- Detailed process flows for each bot transaction that includes every POSC screen that the bot will engage in the process, and
- The full end-to-end activity of each bot transaction the organization is seeking approval.
3) Test Scenarios. This must include a list of successfully executed test scenarios for each transaction that each bot will perform on the POSC. The test scenarios must
- Cover the full end-to-end activity of the bot
- Address each POSC screen accessed by the bot, and
- Ensure compliance with Section 2 of the MassHealth RPA Agreement. This compliance may also be demonstrated via documented statements where applicable.
What happens if I do not register a bot that is actively conducting transactions on the POSC?
If you are actively using a bot that is conducting transactions on the POSC and you have not submitted a registration request to MassHealth for approval, you are out of compliance with MassHealth’s RPA policy and subject to enforcement. You must submit a registration request to MassHealth immediately.
Please note that MassHealth will monitor the POSC to identify any unauthorized bots. The User ID of any unauthorized bot identified on the POSC will be subject to termination, and the organization may be prohibited from using RPA tools on the POSC if the organization does not cure the violation.
Can I request Stage II approval for transactions that were not approved within the Stage I registration request?
No. The Stage II registration request can include only those requests that were previously approved within Stage I. If the organization wants to request the ability to conduct additional separate bot transactions, it must submit a separate MassHealth RPA Stage I Registration Form.
Do I need to test my bot transaction before submitting a MassHealth Stage II Registration Form or Modification Request Form to MassHealth for approval?
Yes. You should test all bot transaction in the MassHealth Trading Partner Testing Environment before submitting your request to MassHealth where applicable.
I don’t expect the bot to perform transactions each week. How should I calculate the average number of transactions for the Stage I form?
Estimate the average number of transactions the bot will perform each month and divide by 4.
Why can't I create my own User ID for the bot to function under?
MassHealth User IDs contain characteristics that will enable MassHealth to track approved bots.
If I have any questions regarding MassHealth’s RPA policy and related procedures, whom should I contact?
Please contact MassHealth at functional.coordination@mass.gov.
RPA Monitoring, Modification, and Annual Validation
Will MassHealth monitor my bot once it has been approved?
MassHealth will monitor all registered bots to ensure that they are performing only the POSC transactions officially approved by MassHealth and that they are in compliance with signed the MassHealth RPA Agreement.
My bot has been approved by MassHealth, but I would like to modify the bot's activity. Do I need to request approval from MassHealth to modify the bot?
Yes. You must complete and submit the MassHealth RPA Modification Form to MassHealth for review and approval. Organizations can request modifications to replace an RPA tool, increase or decrease the POSC screens the bot will interact with per session, retire a bot, and a host of other modifications. Organizations can access the MassHealth RPA Modification Request Form at www.mass.gov/rpapolicy.
Do I need to submit a new Stage I Registration Form if I want my approved bot to perform additional transactions beyond what has already been approved?
It depends on whether the additional transactions will be conducted sequentially within the same session or in separate sessions.
The organization should submit the MassHealth RPA Modification Request Form if it is requesting the ability for the bot to perform a secondary sequential transaction within the same bot session. For example, if the approved bot currently performs an eligibility inquiry, and the organization now wants the bot to submit a claim immediately upon the receipt of the eligibility response within the same bot session, it should submit the Modification Request Form, since the two actions will be part of one session.
The organization should submit the MassHealth RPA Stage I Registration Form if it is requesting the ability to submit a separate bot transaction, independent of the approved transaction. For example, the bot is approved to perform an eligibility inquiry only, and the organization now wants the bot to perform a claims submission independent of the eligibility inquiry and this claims submission will not be performed sequentially within the same bot session. In this case, the organization should submit the Stage I Registration Form. This is because the two actions will be part of two separate sessions.
Will MassHealth require any additional information or confirmations from my organization once the bot is approved?
Yes. MassHealth will require each organization to validate its use of approved bots on an annual basis. MassHealth will outreach to organizations to conduct the validation
Contact for RPA Policy–Frequently Asked Questions (FAQ)
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| Last updated: | October 3, 2022 |
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