Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006Req #GT.116GT.117GT.118GT.119GT.120GT.121GT.122GT.123GT.124GT.125GT.126GT.127GT.128GT.129GT.1307. General and Technical (GT)Description of RequirementUtilize open architecture standards and scalability to promoteintegration throughout all MMIS business processes and subprocesses.Provide a user-friendly, common "look and feel" which gives usersa seamless MMIS experience across the "core system," including(at a minimum) the Member Management, Provider Management,Claims Processing, Reference File, and TPL modules, andmaintains common user elements across the entire MMISwhenever possible.Data changes made in one part of the system should automaticallypopulate other parts of the system so as to avoid duplicate dataentry.All on-line claim/encounter information is to be available toauthorized users regardless of the functional business area wherethe data is stored.Ability to "lock" a claim to prevent concurrent updates to the sameclaim.Adjudicated claims are not to be changed outside an approvedadjustment process. Once a claim is adjudicated and in a finalstatus, the information is to remain static while it is displayed (e.g.,users may not cut claim information from claim lines/data).Ability to maintain an integrated repository of Memberinformation, including a single unique identifier (which is not theSSN), for all Members where payments are made from the newMMIS system.Ability to maintain an integrated repository of Providerinformation, including a single unique identifier (NPI), for allProviders.10. System InterfacesAbility to interface and/or integrate with the systems andapplications as specified in the Integration Points Table of thisdocument. (See the following Procurement Library folder/file:Interfaces/WV_MMIS_External_Interfaces.pdf).The system is to receive and send electronic interface informationfrom and to the State’s eligibility systems, other agencies, andBMS’s outside Vendors (as specified in the Integration PointsTable of this document).Ability to accept eligibility data from multiple source systems intoa Vendor supplied common eligibility interface component. Thecommon eligibility interface component is to edit for dataaccuracy, completeness, redundancy, etc., according to specifiedbusiness rules, reformat the data and provide a single interface tothe MMIS. The common eligibility interface component is to alsoassure data delivery.The system is to interface with and provide data to a DecisionSupport System/Data Warehouse.Ability to produce required Federal and State data sharing,including (but not limited to) the following:Program management reports (formerly known as Managementand Administrative Reporting Subsystem (MARS))YESwithoutcustomizationXXXXXXXXXXXXXXYESwithcustomizationNOunabletoprovide14.2-94