Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMCustomer Service RequestCutoverDAFData ElementData Element NumberingData EntryData IntegrationData ObjectData SourceDayDDIDecision Support SystemDEDDeductible and CoinsurancePortions of Health CareBenefits Paid under TitleXVIII of the Social SecurityActDeemedDelegated ServicesDelegationDeliverableDenied AuthorizationDenied ClaimDepartment of Labor andIndustryDEFINITIONmarketing, customer service, training, professional development, performancemanagement, human resource development, and compensationAn official work request notification to the Fiscal Agent to initiate an update,research discrepancy modify or complete maintenance work in theMMIS/PBM/DSSThe date on which the successful bidder begins full and complete operation of theLMMIS.DDeliverable Acceptance FormA specific unit of information having a unique meaning.Set of numbers (e.g., 1000-1999, 2000-2999) allocated to each subsystem forassignment to data elements that originate in that subsystem.The process of entering claims data into the MMIS.Ability to produce and/or consume the same data from multiple systems, physicallocations, and diverse vendorsA data structure used in object linking and embedding that enables a user to exporta document from an application, edit it in another application, and then re-importit into the original applicationThe storage location for the data used in a report (e.g., a Microsoft Excelspreadsheet)Calendar day, unless specified as a business dayDesign, Development and ImplementationComponent of a data warehouse that provides analytical-level queries andreportingData Element DictionaryClaims of this type will represent a request for payment by Medicaid of thedeductible and coinsurance portions of claims submitted Medicare to whichMedicare has made a payment determination.Deemed Cash Assistance Member with MedicaidAdministrative services that are contracted out to a third partyThe assignment of member activity to another entity by transferring financial riskfor a group of services to that entityAll software, documentation, reports, manuals, and any other item that the Vendoris required to produce and/or tender to the State under terms and conditions of thisContractAuthorizations that have been reviewed and denied, and which will prevent theClaim Manager module from processing the claims against the services on theauthorizationA claim for which no payment is made to the provider because the claim is fornon-covered services, is for an ineligible provider or recipient, is a duplicate ofanother similar or identical transaction, or does not otherwise meet State standardsfor paymentThe agency that is responsible for licensure of most healthcare professionals14.14.2-10