Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMGeneral System DesignGeographical InformationSystemsGeographic Price CostIndicesGroup PracticeGSAGuardian IDHCBSHCPCSHealthcare CommonProcedure Coding SystemHealth PlanHealth Plan IDHealthy ConnectionsHealth InsuranceProspective Payment SystemThe Health InsurancePortability AndAccountability Act Of 1996HHSHIEDEFINITIONDefines the major feature and functions of an automated system to include majorsystem logic, reports, screens, and input forms and files required for a certifiableMMISSoftware program that allow data to be displayed spatiallyAn index of cost comparisons used to pay claims adjusted by geographic locationduring the adjudication processA medical practice in which several providers render and bill for services under asingle provider number.General Services AdministrationThis field will house the Case Number from IBISHHome and Community Based ServicesHealthcare Common Procedure Coding SystemA coding system designed by CMS that describes the physician and non-physicianpatient services covered by Medicaid and Medicare Programs and used primarilyto report reimbursable services provided to patientsThe health insurance organizationFor internal use (as in Medicaid claims processing) the Health Plan ID is the fieldthat holds the Medicaid ID. In external situations (such as TPL/TPR) the HealthPlan ID is the group subscriber ID or the external organization’s identifier for theinsured.On the Member Summary screen this will be the Medicaid ID. On the Eligibilityscreen it will be the Medicare ID for the Medicare segment, subscriber ID forwhatever other external health plan segments are shownA primary care case management (PCCM) model of managed careSpecific sets of patient characteristics (or case-mix groups) on which paymentdeterminations are made under prospective payment systems; at least one HIPPScode is defined to represent each case-mix group and may need to be included onthe UB-04 claim formA Federal law that includes requirements to protect patient privacy, to protectsecurity of electronic health information, to prescribe methods and formats forexchange of electronic administrative transactions, and to uniformly identifyprovidersHealth and Human ServicesHealth Information ExchangeHIPAA Health Insurance Portability and Accountability Act of 1996HIPPHistorical FinancialTransactionHistory FileHITHITECHHealth Insurance Premium PaymentAn open financial transaction from a legacy accounting system; it may beconverted from the legacy system to a new accounting system to become an activefinancial transaction on the new systemA file containing extracts of all past paid claims (or past recipient activity or pastprovider activity) that can be used for surveillance and trend development.Health Information TechnologyHealth Information Technology for Economic and Clinical Health Act14.14.2-16