Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006Req #PG.188PG.189PG.190PG.191PG.192PG.193PG.194PG.195PG.1964. Program Management (PG)Description of RequirementAbility to accept on-line updates, additions, and deletions, with theability to make changes to individual records or mass changes togroups or classes of records (e.g., across Provider type andspecialty).Ability to accept manual and automated updates, additions, anddeletions by electronic transmission to all reference files, with theability to make changes to individual records or mass changes togroups or classes of records (e.g., across Provider type andspecialty).Ability to implement automated load processes to apply code setupdates when updates are made available by CMS or other datapublishing sources.Ability to support the transition to future versions of code sets(e.g., ICD-11).All reference file updates are expected to be tested by Vendor andapproved by BMS prior to moving data to production.Ability to alert designated BMS staff upon completion of updatesof reference file data. This alert should identify all changes andrevisions, deletions, and replacements and provide a crossreference.Ability to perform mass updates, from multiple sourcesdetermined by BMS, on the test region and upon approval migrateto production on a schedule defined by BMS.Ability to assure updates do not overlay or otherwise makehistorical information inaccessible. Should maintain back-upfeatures to assure changes in parameters are maintained.Ability to allow the tracking of changes to the reference file usingon-line notes capability.YESwithoutcustomizationXPG.197 Ability to maintain effective dates for all code sets. XPG.198 Ability to add values or update any code set attributes. XPG.199 Ability to maintain a map of procedure codes to diagnosis codes to Xdefine valid/invalid combinations.PG.200 Ability to maintain a map of 11-digit NDC codes to J-codes (i.e.,Healthcare Common Procedure Coding System (HCPCS) Level IIcodes) through electronic updates.XPG.201PG.202PG.203PG.204PG.205PG.206Ability to associate National Drug Codes (NDCs) with theirtherapeutic indicators.Ability to maintain an on-line cross-reference between HCPCSand International Classification of Diseases-10 (10th revision)-Clinical Modification (ICD-10-CM) procedure codes.Maintain an on-line cross-reference between ICD-10-CM andDSM diagnosis codes and DSM diagnosis, including DSM age 0-3diagnosis.Ability to maintain a map of ICD-10 (International Classificationof Diseases, version 10) surgical procedure codes to CPT (CurrentProcedural Terminology) procedure codes to apply claimsprocessing functions based on the CPT code.Ability to maintain a map of Revenue codes to CPT procedurecodes to apply claims processing functions based on the CPT code.11. Maintain Benefit/Reference Information - Benefit PlansXXXXXXXXXXXXXYESwithcustomizationNOunabletoprovide14.2-61