Molina Medicaid Solutions - DHHR

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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
Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130064. Program Management (PG)YESwithoutReq #Description of RequirementcustomizationPG.235 Relative value units XPG.236 Edit/audit criteria and disposition tables XPG.237 Business rules XPG.238 Ambulatory Payment Classifications (APCs) XPG.239 Base units for American Society of Anesthesiologists (ASA) XcodesPG.240 Coding values that indicate if a procedure is covered byX<strong>Medicaid</strong> or other programsPG.241 Authorized specialty and taxonomy XPG.242 Required Clinical Laboratories Improvement Amendments X(CLIA) certification typePG.243 PA requirements (e.g., always required, sometimes required, Xnever required)PG.244 Valid/invalid Place Of Service (POS) limitations XPG.245 Recipient age/gender restrictions XPG.246 Contraindicated edits XPG.247 Pre and post-operative days XPG.248 Once-in-a-lifetime indicator XPG.249 Never events (TBD) HAC XPG.250 Two digit place of service XPG.251 Co-pay indicator, and associated data including the co-payment Xamount/per service unit and/or aggregate out-of-pocket copaymentthresholds for the servicePG.252 Aid category, rate code, RAPIDS program code, or MAS/BOE XcodePG.253 Family planning indicator (method defined by BMS) XPG.254 Emergency indicator XPG.255 Claim type XPG.256 Diagnosis code requirements including the list of valid/invalid Xdiagnosis codes and if diagnosis is required (header/line) forclaims adjudicationPG.257 Units of service XPG.258 Review indicator XPG.259 Tooth number or letter XPG.260 Tooth surfaces XPG.261 EPSDT indicator XPG.262 Anesthesia base values XPG.263 Duplicate check XPG.264 Indicator of TPL actions, such as cost avoidance, benefitXrecovery or pay, by procedure code.PG.265 Indication of MCO carve-outs XPG.266 Procedures manually priced or manually reviewed XPG.267 Limits of the procedure XPG.268 Indication of non-coverage by third-party payers XPG.269 Information such as accident-related diagnosis codes forXPG.270possible TPL, Federal cost-sharingIndicators for surgical, bi-lateral surgical, and endoscopyproceduresXYESwithcustomizationNOunabletoprovide14.2-63
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Molina Medicaid SolutionsResponse t
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e10vkTable of ContentsItem 1:Overvi
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e10vkDepartment of Health Services
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e10vkservices, and reputation or na
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e10vkIf our government contracts ar
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e10vkIf our cost increases resultin
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e10vkour board of directors. Becaus
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e10vkFirst Quarter $ 44.94 $ 23.46S
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e10vkTable of ContentsCertain compo
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e10vkNevada 8,037 1,106.45 9,099 1,
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e10vkInvestment IncomeInvestment in
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e10vkand 2007, respectively. EBITDA
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e10vk$2.8 million, or $0.10 per dil
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e10vkREPORT OF INDEPENDENT REGISTER
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e10vk65Table of ContentsMOLINA HEAL
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e10vkDelegated Provider InsolvencyC
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e10vk2007 (see Note 11, “Long-Ter
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e10vk$ 252,380 $ 248,039Gross reali
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e10vkTable of ContentsMOLINA HEALTH
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e10vk$10.9 million, and $7.9 millio
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e10vkIn July 2008, our board of dir
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e10vkThe Registrant has an equity i
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e10vkSIGNATURESPursuant to the requ
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exv12w1EX-12.1 2 a51362exv12w1.htm
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e10vkEX-31.1EX-31.2EX-32.1EX-32.2Ta
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e10vkLeverage operational efficienc
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e10vkhealth plans. Among such facto
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e10vkMissouri and Ohio health plans
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e10vkWe are subject to various rout
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e10vkIt may be difficult for a thir
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e10vkItem 5:PART IIMarket for Regis
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e10vkstates to exclude certain bene
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e10vkMedical care ratio 86.8% 84.8%
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e10vkTable of ContentsMedical care
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e10vkare required to pay a fee for
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e10vkknown. While we believe our cu
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e10vkYear Ended December 31,2009 20
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e10vkCalifornia $ 481,717 $ 417,027
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e10vkMOLINA HEALTHCARE, INC.NOTES T
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e10vk2008, we had transitioned fewe
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e10vknot intend to sell, nor is it
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e10vkDuring 2009, 2008, and 2007, t
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e10vk$29.17 - $30.05 9,350 5.9 $ 29
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e10vk(1) The Registrant’s condens
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e10vkChanges in Internal Controls:
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e10vkSignature Title Date/s/ Joseph
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exv10w22Commitments exceed the sum
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exv10w22Loan Document. The amendmen
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exv10w22Name:Title:Fifth Amendment
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exv10w22Fifth Amendment to Credit A
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exv10w24EX-10.24 3 a55407exv10w24.h
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exv10w24Molina ECMS ref# 729 Provid
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exv10w24HSA — Hospital Services A
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exv10w243.2 Member Eligibility Dete
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exv10w245.6 Amendment. Health Plan
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exv10w24HSA — Hospital Services A
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exv10w24License No. StreetNPI (or U
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exv10w24Page 23 of 40ATTACHMENT CPr
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exv10w24• This reimbursement meth
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exv10w24(Rule 53250(e)(4))8. Provid
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exv10w241. Right to Audit. Provider
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exv10w24Treasurer G. William Hammer
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exv10w25unless the situation is one
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exv10w25Plan in identifying, proces
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exv10w25Page 9that the offset and r
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exv10w25under this Agreement.h. Hea
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exv10w25Page 16Date 6/1/06ATTACHMEN
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exv10w25that Provider is de-delegat
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exv10w25the subscriber or Member by
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exv10w25discretion, that Provider h
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exv10w252.5 Annual Disclosure of Ca
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exv10w25Initials of authorizedrepre
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exv10w25the report is true and corr
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e10vk10-K 1 a58840e10vk.htm FORM 10
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e10vkOur StrengthsWe focus on servi
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e10vkevent.CompetitionWe operate in
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e10vkat the funding for these healt
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e10vk18Table of ContentsAlso, many
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e10vkTable of Contentsalleged non-c
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e10vk(fair value of $20.4 million).
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e10vkTable of ContentsSTOCK PERFORM
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e10vkAs of December 31, 2010, our h
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e10vkYear Ended December 31,2010 20
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e10vkAcquisitionsWisconsin Health P
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e10vkspecific performance measures
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e10vkoverestimations were tied to o
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e10vkIntangible assets, net 105,500
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e10vkOur Health Plans segment compr
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e10vkSituations may arise where the
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e10vkinvestment fund. As of Decembe
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e10vk7. ReceivablesHealth Plans seg
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e10vkindebtedness under the Credit
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e10vkstatutory capital and surplus
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e10vkCash paid in business purchase
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e10vkItem 12.Security Ownership of
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exv10w27EX-10.27 2 a58840exv10w27.h
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exv10w27(f) all transferable or ass
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exv10w27and other charges have been
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exv10w27under or affecting the Prop
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exv10w27BY A GENERAL RELEASE, WHICH
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exv10w27(f) Seller’s share of the
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exv10w2710.6 Items Not to be Prorat
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exv10w27- 21 -(i) Delinquency Repor
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exv10w27executed, and delivered by
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exv10w27MATERIALS THAT PERTAIN TO T
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exv10w27Attn: General CounselTeleph
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exv10w2718.16 Authority. The indivi
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