What Is a Line of Business?

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A line of business identifies for the ND MMIS customer who has the overall responsibility for processing and paying claims for its members. Basically, a line of business is a source of funding. A line of business (LOB) is one of the codes, or rules, that must be set up before ND MMIS can process claims. Almost everything in ND MMIS is connected to a line of business, from claims to financials.

Lines of business (LOBs) are independent organizations of the ND MMIS customer that define benefit plans, may process and price claims differently, and must be managed and accounted for separately. For example, when a procedure code is billed on a claim, one line of business may cover that procedure code's service in one of its benefit plans, but another line of business may not.

LOBs can also be used to customize text used for procedure codes and revenue codes in the Text Management area of the Rules Management function. The text that is printed on the explanation of benefits sent to members can be changed for each line of business, if needed.

LOBs and the hierarchy of units that report in to them are also used to manage contact management groups.

LOB Examples

Medicaid is an example of a line of business. State Employees, State Teachers Association, and a Board of Regents are other examples. A business unit or department within a state organization that administers a particular health program is not necessarily a separate line of business, but may be considered a separate business unit. However, benefit plans can be associated with these business units, in addition to a line of business. A fund code is also not a line of business. Multiple lines of business may use the same fund codes, but may assign those fund codes differently.

Maintaining LOBs

Normally you add lines of business when ND MMIS is set up for the first time using the Line of Business function of Rules Management. The types of lines of business, for example Medicaid or State Employees, must already be set up as valid values. Additional lines of business can be added when needed.

Lines of business are effective-dated to allow you to close (end-date) a line of business that is no longer available, but must remain in ND MMIS for historical record-keeping and retroactive claim adjustments.

Each line of business is associated with only one customer. A customer can have multiple lines of business. Every benefit plan must be connected to a line of business when the plan is added. Multiple provider networks, benefit plan map definitions, and benefit plans can be associated with one line of business. If the line of business is not set up and maintained properly, claims could be paid incorrectly or not paid at all.

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