Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMKPILANLEIELifetime MaximumLifetime Reserve DaysLimits Effective DateLimits Termination DateLine StatusLLCLock InMAFManaged CareManual PricingMan DayMan HourMan MonthMan WeekMan YearMAPPMARMASMaximum Out Of PocketMCOMDMdental screening services.Key Performance IndicatorLLocal Area NetworkList of Excluded Individuals/EntitiesDEFINITIONLimits on the total dollar amount of eligible services a member may receiveduring their lifetimeEach Medicare patient is entitled to a lifetime reserve of 60 additional hospitaldays that can be used after the standard 90-day inpatient stay within a benefitperiodThe starting date of the accrual and deductibleThe date the accrual of deductibles and accumulators is scheduled to end. If aclaim is processed with a date of service after the member's limits terminationdate, deductible and accumulator amounts will not be calculated in plan limits forthe specified time periodStatus of a claim detail lineLimited Liability CorporationAn MMIS/DSS function that a Medicaid recipient receives certain benefits from asingle, identified source. Lock-In is most used in Pharmacy Benefits Managementto require a potentially abusive recipient to pick up prescriptions at a certainpharmacy only. Lock-In is used in managed care to require a recipient to receivecare through a certain HMO or service network for a set period of timeMMilestone Acceptance FormA term denoting management of recipient care by a provider or case manager toencourage maximum therapeutic efficacy and efficiency through service planningand coordination. Also used in reference to prepaid, capitated health systems.Pricing a claim “by hand”. Usually performed due to the special nature of theservice, e.g., no code exists; no allowed amount exists for a covered benefit, etc.Eight (8) man hours.Sixty (60) minutes during which an employee of either the Contractor or theDepartment is actively performing an assigned task.Twenty-one and a half (21-1/2) man days.Five (5) man days.Twelve (12) man months.Medicare Automated Premium PaymentManagement and Adminsitrative ReportsMinimum Acceptable ScoreThe total dollar limit a health plan member is required to pay under his/her benefitplan in the form of co-payments, deductibles, and coinsurance during a specifiedtime period. A health plan may or may not include co-payments in maximum outof pocket calculationsManaged Care OrganizationMDMMaster Data Management14.14.2-19