Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMCase SupervisorCategorically NeedyCategory of ServiceCDCDCCenters For Medicare AndMedicaid ServicesCertificationCertified Family HomeProviderCFRChange Control BoardChange RequestCharge Back Risk PoolCheck DigitCheck RegisterChildren’s Health InsurancePlanCHIPChoose to BargeCIBCINCine ModeClaimClaimCheckDEFINITIONmay do predefined case assessments as wellSupervises Case Managers and their workload; manages the Health PAS CaseManagement application and performs queries on the data.All individuals receiving financial assistance under the State’s approved plan.A classification of medical services authorized under Medicaid (e.g., physician,inpatient hospital, ICF, etc.).Continuously Dedicated StaffCenters for Disease ControlThe organizational unit of the U.S. Department of Health and Human servicesresponsible for administration of the Title XIX Program under the Social SecurityActWritten acknowledgment from CMS that the operational MMIS meets all legaland operational requirements necessary for 90 percent and 75 percent FederalFinancial Participation (FFP)A home for one or two adults who are elderly, have a mental illness, physical ordevelopmental disability which allows them to live in a safe setting; the home isoperated by a provider with special training and proven skills in providing safe,effective services to the residentsCode of Federal RegulationsA board made up of State staff and Contractor staff that will review and approveor deny all requested changes to the system.A perceived need for an addition, modification, or deletion to an existing projectitem or system; it is an essential tool in the process for controlling and managingproject changesA risk pool that applies to all defined services within a contract term. This optionis primarily used whenever certain services are allocated to predefined pools.These services are part of a financial agreement between the health plan and thecontracting provider. At the end of the fiscal year, the amount of monies spent onthese services is calculated, and the contracted provider receives a percentage ofthe total remainder, if applicable.A computer generated digit that becomes part of the provider ID number atenrollment time and is used for a validity check in claims processing.An output of the Claims Processing Subsystem which list checks approved fromthe current adjudication cycle.A fee-for-service benefit plan managed on the MMIS and through a state contractwith a specific vendorChildren’s Health Insurance ProgramChoice of the call center supervisor in a Web chat to communicate to both the callcenter customer service representative and the Health PAS-OnLine user engagedin a web chat interactionContinuous informationClient identification numberText printed from top to bottomA request for a benefit plan to pay for healthcare servicesMcKesson product that performs comprehensive coding audits of claims havingCPT, HCPCS and ICD-9/ICD-10 codes14.14.2-6