Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130064. Program Management (PG)YESwithoutYESwithReq #Description of Requirementcustomizationizationcustom-PG.358 VFC (Vaccines for Children program) pricing and rates by Xprocedure codePG.359 National Drug Code (NDC) (used for pricing hospital claims) XPG.360 Transportation pricing XPG.361 Non-specified formula pricing, where non-specified formula Xpricing would refer to having a PA price a claimPG.362 Other as identified by BMS during DDI and accepted viaXformal change controlPG.363 Ability to maintain the following hospital-specific inpatient and Xoutpatient rate data, by effective date(s) including:PG.364 Inpatient DRG rate components XPG.365 Inpatient and outpatient cost to charge ratios XPG.366 Other hospital specific payment components such as per diems, XpercentagesPG.367 Ability to accommodate multiple outpatient hospitalXreimbursement methodologies based on business rules provided byBMS, including:PG.368 Outpatient prospective payment XPG.369 Per discharge/visit XPG.370 Percent of charge XPG.371 Fee-For-Service (FFS) procedure code prices for outpatient Xhospital carePG.372 Line level and revenue center code pricing XPG.373 Other as identified by BMS during DDI and accepted viaXformal change controlPG.374 Ability to accommodate multiple inpatient hospital reimbursement Xmethodologies based on business rules provided by BMS,including:PG.375 DRG XPG.376 Per discharge/visit XPG.377 Per diem XPG.378 Percent of charge XPG.379 Line level and revenue center code pricing XPG.380 Other as identified by BMS during DDI and accepted viaXformal change controlPG.381 16. Maintain Benefit/Reference Information - Reference File ICD-CM Coding SetPG.382 Ability to maintain a Diagnosis set that utilizes ICD-CM coding Xsets. The diagnosis data set is expected to contain, at a minimum:PG.383 Age XPG.384 Gender XPG.385 Family planning indicator XPG.386 Prior authorization indicator XPG.387 EPSDT indicator XPG.388 TPL trauma and emergency trauma codes XPG.389 Inpatient length of stay criteria XPG.390 Accident/trauma indicator XPG.391 Begin date XPG.392 End date XPG.393 Add date XNOunabletoprovide14.2-67