Molina Medicaid Solutions - DHHR

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Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130067. General and Technical (GT)YESwithoutReq #Description of RequirementcustomizationGT.473 Conform to any State, Department or Bureau specifiedXstandards regarding the look and feel of the web.GT.474 Support multiple communication lines and provide fail-overXcapability.GT.475 Provide growth capacity for high volumes of activity. XGT.476 Ability to interface, receive, send, and download specified content Xand reporting information directly from/to entities such as Providerassociations, vendors, and other State agencies.GT.477 Include email address in the authorization table. TheXconfidentiality of email addresses is to be protected and only usedfor official State business.GT.478 Allow for (HIPAA-compliant) email submission by user initiated Xfrom a link on the website.GT.479 Provide flexible web-based reporting that meets external reporting Xneeds and requirements defined by BMS.GT.480 Ability to ensure that web portal field definitions comply with Xsystem field definitions.GT.481 Provide inquiry capabilities for categories including: XGT.482 Prior Authorization (PA) XGT.483 Remittance Advice (RA) XGT.484 Provider 1099 information XGT.485 Other as identified by BMS during DDI and accepted viaXformal change controlGT.486 Ability to generate tracking numbers for web portal-submitted XProvider enrollment applications and updates.GT.487 Ability to provide interactive/dynamic online forms that may be Xcompleted and submitted online, completed and printed for hardcopy submission (i.e., mail, fax), or printed to be completed byhand and submitted in hard copy format.GT.488 Ability to allow users to download or print a copy of completed Xsubmitted forms.GT.489 Ability to accept electronic attachments via the web portal and Xmatch them to the corresponding system record (includingenrollment applications).GT.490 Ability to require applicants to state that they meet the StatedefinedXProvider eligibility rules (WV code referencing digitalsignature: http://www.legis.state.wv.us/WVCODE/GT.491Code.cfm?chap=39a&art=1).The web portal should allow authorized users to performElectronic Data Interchange (EDI) transactions, such as, but notlimited:GT.492 Interactive Eligibility Verification (270/271 – Direct Data XEntry (DDE) compliant)GT.493 Interactive Claims Inquiry (276/277 – DDE compliant) XGT.494 Interactive Claim Submission (DDE compliant) to allow aProvider to submit a claim, including HIPAA/EDI compliantresponsesXGT.495 Remittance Advice (RA) (835) XGT.496 Interactive claim submission (837 transactions) XXYESwithcustomizationNOunabletoprovide14.2-108
Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006Req #GT.497GT.498GT.499GT.500GT.5017. General and Technical (GT)Description of RequirementOther transactions as specified by BMS (which may include,but not necessarily limited to: eprescribing, personal healthrecord, health information exchange of lab and/or clinical data)Provide the capability to display confirmation messages forrequestor transactions.Provide help screens and tutorials (e.g., guides to the Providerenrollment and Prior Authorization processes).Provide on-line option for end-users to report any technicalproblems with the web application and web pages.Ability to report and maintain web portal activity statistics (asdefined by the BMS). For instance: new and repeat visitors,number/percent of abandoned enrollment applications, etc.YESwithoutcustomizationXGT.502 22. Web Portal - Long Term Care (LTC) Provider Rate Submission & InquiryGT.503 Ability to allow Providers to submit and upload to BMS (via the Xweb portal) the following:GT.504 Cost reports XGT.505 Provider acceptance of the verification report XGT.506 Rate reconsideration requests XGT.507 Provider correspondence XGT.508GT.509GT.510GT.511GT.512Ability to accept and transfer specified files to and from Providersto the MMIS via the web portal.Ability to send cost report verification to user if no errors arefound during edits and supply Providers with a method to agree tothe verification.Ability to provide a private document page that displays a list ofthe available documents for each logged-in Provider.Ability to upload rate information in batch or in bulk (i.e.,reimbursement rates information that it is provided to RAPIDS.Vendor should propose the most economical format).Ability to provide Provider-specific inquiry access to securedinformation. Vendor should propose the more economical format.The pay-to amounts are expected to be provided to the Vendor.Examples include:GT.513 Automated Cost Report (ACR) (data and reports) XGT.514 Error reports as part of the cost verification process XGT.515 Rate setting package report XGT.516 Cost verification report XGT.517 Provider acceptance of the Verification report XGT.518 MDS error/authorization reports XGT.519 Individual Assessment Form (IAF) scores XGT.520 IAF error reports XGT.521GT.522Web Portal - Patient Care Web PortalAbility to provide system functionality that allows Providersaccess to Member claims data (pharmacy, medical and MCOencounter data) for the purposes of coordinating patient care andreducing duplications in medical procedures, diagnostic testingand medicationsXXXXXXXXXYESwithcustomizationNOunabletoprovide14.2-109
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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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