Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMDHHRDiagnosisDiagnosis CodeDiagnosis Related GroupDisableDisaster Recovery AndBack-Up PlanDisallowDiscount FFSDiscount UCRDiscussionsDisease ManagementDispensing FeeDisproportionate ShareHospitalDLPDMERCDOADocument ClassDouble-blind KeyingDRGDrug RebateDEFINITIONDepartment of Health and Human ResourcesThe classification of a disease or conditionAn alphanumeric code used to identify the diagnosis of a patient’s illness,disorder, or symptoms; also referred to as an ICD-9 codeA prospective inpatient hospital reimbursement methodology used in Medicare.Under DRG, a single flat amount is paid per discharge.Deactivate a business rule in claims adjudicationA plan to ensure continued claims processing through adequate alternativefacilities, equipment, back-up files, documentation and procedures in the eventthat the primary processing site is lost to the ContractorTo determine that a billed service(s) is not covered by Medicaid and will not bepaid.Payment pricing based on a percentage of billed chargesPayment pricing based on a predefined health plan or state-defined reduced UCRfee scheduleFor the purposes of the SFP presentations, a formal, structured means ofconducting written or oral communications/presentations with responsibleProposers who submit proposals in response to this SFP.A program that coordinates education, communication, and health careintervention for a population with a chronic condition, such as diabetes orhypertension, which self-care efforts can significantly improve the quality of lifeand reduce healthcare cost by reducing or preventing the effects of the condition.The dollar amount paid to a dispenser of drugs as compensation for hisprofessional services.Payments made by the Medicaid program to hospitals designated as serving adisproportionate share of low-income or uninsured patients. DSH payments are inaddition to regular Medicaid payments for providing care to Medicaidbeneficiaries. The maximum amount of federal matching funds available annuallyto individual states for DSH payments is specified in the federal Medicaid statute.Desk Level ProceduresDurable Medical Equipment Regional CarrierDepartment of AdministrationPart of the meta data with a document to direct it to the appropriate documentlibrary, orHigh level organization of documents within EDMS that corresponds with themajor functional areas of Health PAS (e.g., claims, member, provider, utilizationmanagement); document types fall under document classesA method of ensuring data is correctly entered for important indexes. Forexample, a data entry clerk will enter a SSN, hit enter and the value will clear,then the data entry clerk will enter the same value a second time. The values mustmatch for the data entry clerk to move on to the next data fieldDiagnosis-related GroupProgram authorized by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90) in which legend drug manufacturers or labelers enter into an agreement withthe Secretary, DHHS, to provide financial rebates to States based on dollaramount of their drugs reimbursed by the state Health Care Programs14.14.2-11