Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMBENDATABENDEXBeneficiaryBenefitsBenefit PeriodBenefit PlanBilling ProviderBilling Provider IDBizTalkBookmarkBMSBSBUBusiness DayBuy-InDEFINITIONThe input file to BENDEX (Beneficiary Data Exchange)Beneficiary Data Exchange System – A file containing data from the Federalgovernment regarding all persons receiving benefits from the Social SecurityAdministration. This file is received and processed by TEAMS/CHIMES, theState’s eligibility determination system, and the data is forwarded to the MMISThe Medicare term for a recipient.A schedule of coverage that an eligible participant in the program receives forspecific health care services for the treatment of illness, injury or other condition.The period that begins when the patient enters a hospital and ends 60 days afterthe patient is dischargedBenefit Plan is the aggregate services that a member can receive, along with anycriteria that should be used during claim adjudication, such as age, gender, placeof service, service and visit limits, or other configurable parameters. Theindividual sets of services that make up the Benefit Plan are divided into benefitsand contain benefit properties that delineate the criteria based on the health planpolicyThe provider who is submitting the claim. Can be a different provider from theservicing or rendering provider.ID of the provider under whose name a claim is submitted for services to amemberBizTalk is an EAI (Enterprise Application Integration) product from Microsoft,used to transform X12N transaction to XML and vice versa for communication inand out of Health PAS-AdministratorEditable AreasBureau for Medical ServicesBachelor of ScienceBillable UnitsA day scheduled for regular state employees to work; Monday through Fridayexcept holidays observed by regular state employees. Timeframes in the RFPrequiring completion with a number of workdays shall mean by 5:00 p. m. localtime on the last workdayObsolete term/title, see Medicare Savings ProgramA procedure whereby the State pays a monthly premium to the Social SecurityAdministration on behalf of eligible Medicaid recipients, enrolling them in theMedicare Title XVIII Part A and Part B Program. All Buy-In activities aremanaged by TEAMS/CHIMES, the State’s eligibility determination systemCCalendar DayA 24 hour period between midnight and midnight, regardless of whether or not itoccurs on a weekend or holidayCalendar Year A 12 month period beginning on January 1 and ending on December 31CallCall (Event)Call ManagerPoint of contact between a member, provider, or employer affiliated with oneorganization's programs and the appropriate client relations department of thatorganization (e.g., member relations)A type of event that specifies Case Manager contacts (can be by phone)The person who is ultimately responsible for an open call, ensuring that the issueis resolved. Depending upon organizational structure, the call manager may be14.14.2-4