Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130064. Program Management (PG)YESwithoutReq #Description of RequirementcustomizationPG.48 Ability to withhold A/R from current payments. XPG.49 Ability to generate A/R aging. XPG.50 Provides and maintains the capability to process standard financial Xtransactions including recoupments and payouts which cover morethan one claim/service.PG.51 4. Perform Accounting Functions - AdjustmentsPG.52 Ability to associate a transaction control number (TCN) with all Xclaim credits and adjustments.PG.53 Ability to reverse a previously paid claim. XPG.54 Ability to associate a reason code with all claim credits andXadjustments.PG.55 Ability to maintain the record of the original claim when a claim Xcredit is generated.PG.56 Ability for reversal and replacement claims to retain same log Xdate.PG.57 Ability to maintain a minimum of three years of on-line claim Xhistory to be used for adjustment processing upon implementation(e.g., MINIMUM of 3 years available on Day One ofimplementation), including encounter data.PG.58 Ability to link adjustments or replacement claims to immediate Xpredecessor or original claims.PG.59 Ability to associate all supporting documentation for grossXadjustments to the transaction control numbers (TCNs) assigned tothe gross adjustment.PG.60 Ability to assign specified functions at line level (e.g., ignore, Xwarn, pend, pay, deny).PG.61 Ability to access all incoming adjustment requests and claims Xregardless of input media and assign a unique tracking number andan adjustment type identifier.PG.62 Ability to image claim adjustments requests from ProvidersX(including faxes).PG.63 Ability to process returned warrants or EFTs. FunctionalityXshould include:PG.64 Re-establishment of all claims into a to-be paid status XPG.65 Reinstate units and dollars for prior authorized services XPG.66 Ability to place Provider on hold until bank account information XupdatedPG.67 Other as identified by BMS during DDI and accepted via formal XPG.68PG.69change controlAbility to receive and maintain all managed care retroactive andcurrent eligibility enrollment spans and trigger retroactiveadjustment claims.Ability to trigger take backs or payments and generate the contentof 820 Remittance Advice for premium payments to Providers, atBMS-defined intervals.PG.70 Ability to allow adjustments payments for retroactive eligibility. XPG.71 Ability to allow adjustments due to third-party prior payment and Xalert the cost avoidance unit.XXYESwithcustomizationNOunabletoprovide14.2-55