Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMORTOSCAROTOT or WVOTOverpaymentPAPAASPacked decimalPaid ClaimPanel SizesParallel TestingPart A Premium PaymentProgram (MSP)Part A Reduced PremiumPayment (MSP)Part B Premium PaymentProgram (MSP)Part D ClawbackPat. Control No.Patch SheetPay and ChasePay For PerformancePay-To AffiliationPayment Discount TermPayment FundPCCMPCPOperational Readinerss TestingDEFINITIONOn-line Support Collections and ReportingBMS Operations TeamOffice of TechnologyPayment made to a provider in excess of the amount allowed under thereimbursement rules of the benefit planPrior authorizationPhysician Assured Access SystemPA storage mode that places two decimal digits into one byte, each digit occupyingfour bits. The sign occupies four bits in the least significant byteA claim that has resulted in the provider being reimbursed for some dollar amountor a zero paid amountThe number of members assigned to a providerTesting based upon comparison of old and new system results. Requires a periodof parallel operation where both systems operate and used the same data.Premium paid by the State for Part A Medicare coverage for members with lessthan 40 quarters of work creditPremium paid by the State for Part A Medicare coverage for those membershaving at least 30 through 39 quarters of work creditMedicare Part B monthly premiumsRefers to payments that Medicaid makes to cover the costs of outpatientprescription drugs for members who are eligible for Medicaid and who areenrolled in Medicare Part DData field on the UB-04 used by the provider to identify the unique patient servicevisit /period covered by that claim, used by the provider in patient/serviceidentification; may also be called the patient account number or patient’s accountnumber (as on the CMS 1500)Patch Sheets are used to separate multi-page documents within a batch set up forscanning. They use a rudimentary barcode (patch code) that tells the scanner whena new document is beginningA term which denotes the practice of paying a claim on behalf of a recipient withthird party resources and then recovering from the responsible parties. This isdone when the third party resources are not known at the time of payment. Payand Chase is most common with recovery claims involving casualty cases.A mechanism to pay providers additional reimbursement for participation inspecific treatment protocolsAn affiliation designation that allows for professional contractual relationshipsbetween providersThe amount of time a provider has from the date of service to submit a claim inorder for the claim to be considered for payment; also known as timely filingA source of cash or checking account used for claim paymentPrimary Care Case ManagementPrimary Care Provider14.14.2-23