Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMFamily Planning ServicesFEAFederal FinancialParticipationFederal Medical AssistancePercentageFFPFFS PaymentFinal RAPFinancial TransactionFiscal AgentFiscal IntermediaryFiscal MonthDEFINITIONcalculated as the sum of all co-payments and deductibles paid by all members ofthe family. Family maximum out of pocket limits may be calculated on calendaryear, benefit year, or enrollment yearAny medically approved diagnosis, treatment counseling, drugs, supplies ordevices which are prescribed or furnished by a physician to individuals of childbearingage for purposes of enabling such individuals to freely determine thenumber and spacing of their children.Fiscal Employer AgentThe percentage amount contributed by the Federal government towardsadministrative costs in the Medicaid costs or the State Children’s Health InsuranceProgramThe percentage amount contributed by the Federal government towards the costsof most benefits in the Medicaid programFederal Financial ParticipationFee for Service payment, a traditional healthcare payment system, under whichphysicians and other providers receive payment that does not exceed their billedcharge for each unit of service billedThe last RAP submitted at the end of a home healthcare episode. The final RAP isdenoted by a 329 or 339 bill typeA system generated non-claim transaction used to make to related payments orrecovery funds from clients, providers and other entities such as insurance carriersRefers to the Vendor operating the MMIS. A Contractor who processes HealthCare Program provider claims for payments and performs certain other relatedfunctions as an agent for the StateAn organization under contract to perform functions such as claim processing forthe Medicaid Program.The Monthly time interval in a fiscal year.Fiscal Year The twelve month period beginning July 1 and ending June 30. Federal: the 12month period beginning October 1 and ending September 30FlexiFinancialsFMAPFOIAFTEFull Risk ServicesFull Risk TermFundGAAPGAASFlexiInternational’s FelxiFinancials is a suite of commercial off-the-shelf (COTS)software products at the core of our Health PAS Financials solution; it includesmodules for managing accounts payable, accounts receivable, and the generalledgerFederal Medical Assistance PercentagesFreedom of Information ActFull-Time EquivalentA provider who assumes responsibility and is financially liable for the member’scare. If a provider is deemed at full risk for a set of services, any otherpractitioner who provides the same service must meet predefined criteria.(Formerly states as “at risk.”)All services defined within their term are deemed "at risk." All billed services willbe defined as part of the provider's risk agreementA source of cash for the payment of claimsGenerally Accepted Accounting PrinciplesGenerally Accepted Auditing StandardsG14.14.2-15