Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006Req #PG.207PG.208PG.209PG.210PG.211PG.212PG.213PG.2144. Program Management (PG)Description of RequirementAbility to maintain the benefit plan data repository and ensure thatdata is captured, stored and maintained by program per BMSspecifications.Able to create and modify multiple benefit plans that define,identify and maintain separate service profiles under each programin accordance with policy.Ability to maintain and update effective and end dates for allbenefit plans.Ability to provide standardized testing/modeling environment ortools to determine impact of modifications to the benefit plan(s)and/or any of its components.Ability to easily add, delete, or modify benefit plan(s) and/or itsrelated components.Ability to automatically notify staff (as specified by BMS) ofchanges to health plans and/or related components (e.g., databases,modules, rules, etc.) and their effective dates.Ability to allow an existing benefit plan and its associatedcomponents to be copied and renamed (to facilitate the creation ofa new plan).Ability to support a hierarchy of program rules to determine whichprogram the claim will be paid.YESwithoutcustomizationXXXXXXXXYESwithcustomizationPG.215 12. Maintain Benefit/Reference Information - Reference File Procedure Data SetPG.216 Ability to maintain a Procedure Data Set which is expected to Xcontain the following elements:PG.217 International Classification of Disease (ICD)-9/10-CMXdiagnosis and procedure codesPG.218 Approved versions of Health Common Procedure Coding XSystem (HCPCS) procedure codesPG.219 Procedure code data status (active/inactive) code segments Xwith effective begin and end dates for each segmentPG.220 History of full descriptions for procedure codes XPG.221 History of short descriptions for procedure codes XPG.222 Effective and term dates for all items XPG.223 Diagnostic Related Groups (DRG) XPG.224 NDC drug codes XPG.225 HIPAA mandated code sets XPG.226 HL 7 LOINC code sets XPG.227 Current Dental Terminology (CDT) procedure codes XPG.228 Current Procedure Terminology (CPT) procedure codes XPG.229 Indicators associated with selected parameters for use in claims Xprocessing (to determine include, exclude, disregard)PG.230 Multiple modifiers and the percentage of the allowed price Xapplicable to each modifierPG.231 Revenue Center Codes (RCC) XPG.232 Revenue Center Codes (RCC) should indicate if itemizationsof HCPCS codes are required for claims processing andidentify the list of valid/invalid HCPCS codesXPG.233 Provider charge file legacy custom rates XPG.234 Managed care program covered benefits exclusion plans XNOunabletoprovide14.2-62