Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130064. Program Management (PG)YESwithoutReq #Description of RequirementcustomizationPG.159 Provider enrollment XPG.160 Medical, Dental and Pharmacy Medicaid Claims processing to Xensure that claims are paid in accordance with 42 CFR 447 -Payment for Services, and non-Medicaid claims in accordancewith State and Federal PolicyPG.161 Payment processing XPG.162 Adjustments XPG.163 Prior authorizations (PA) XPG.164 Maintain Procedure, Revenue, Drug, Diagnosis, and DRG data XPG.165 Maintain Modifier data XPG.166 Maintain Medicare Action Code data (Medicare Action Code Xdata are action codes that are used in Medicaid cross-overprocessing).PG.167 Maintain Resource Based Relative Value Scale (RBRVS) data XPG.168 Maintain Provider Charge file data XPG.169 Maintain free-form text memo information (Each entry is Xexpected to include identification of user and date/timeentered.)PG.170 Maintain System Parameter data XPG.171 Maintain Edit Code data XPG.172 Identify service frequency limitations XPG.173 Drug Rebate processing XPG.174 Drug Rebate file data XPG.175 Labeler file XPG.176 Drug Rebate Claim file XPG.177 NDC Summary file XPG.178 Produce various reports XPG.179 Other activities as specified by the BMS during the DDI phase XPG.180 Provides user-friendly navigation among the various reference Xfiles.PG.181 Provides on-line inquiry capability to all current reference data. XPG.182 Provides on-line inquiry capability and archive access to historical Xreference data as defined by the BMS Data Retention Policy.PG.183 Provides BMS-designated on-line role-based access forXapproval/update/edit of reference file data tracked through theChange Request process.PG.184 Ability to maintain a history of all code sets, including the source Xand date/time of change, version, and a history of replacements orPG.185PG.186PG.187changes in meaning.Maintains an audit trail record that describes the change, the dateof change, retroactive change, who requested the change, whoauthorized the change, and user id of who implemented thechange.Table design should be flexible to ensure that the MMIS is able toreadily accommodate changes.Inputs to the reference file should include (at a minimum): POSupdates; CMS HCPCS updates; and online and batch updatesrequested by BMS.XXXYESwithcustomizationNOunabletoprovide14.2-60