Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMSSISMESMMSNAPSRMStateState Paid Claims TapeState PlanStatuesStakeholdersStringStub FilesSubcontractorSubmission DaysSubscriberSubscriber IDSubstantive WrittenResponseSubsystemSummary AccountingSupplemental Security IncomeSubject Matter ExpertState Medicaid ManualDEFINITIONSupplemental Nutrition Assistance Program (formerly Food Stamps)Software Release ManagerThe State of West Virginia.The magnetic tape produced by the Contractor that identifies all MedicalAssistance paid claims. The tape is submitted weekly to the Department.The document by which the State outlines to CMS the amount, duration, andscope of Medicaid services to be provided and the reimbursement mechanismutilized in servicing specified groups of eligible.Laws passed by Congress or a State legislature and signed by the President or theGovernor of a State, respectively, that are codified in volumes called “codes”according to subject matterAn individual or group with an interest in the success of an organization indelivering intended results and maintaining the viability of the organization'sproducts and services. Stakeholders influence programs, products, and services.Members and staff of relevant appropriations, authorizing, and oversightcommittees; representatives of central management and oversight entities andrepresentatives of key interest groups, including those groups that represent theorganization's customers and interested members of the publicA sequence of data values that stand for charactersData files or programs that stands in for the original, e.g., the PBM claims stubfile is a file that does not contain all of the claims information, but includes whatis needed for viewing the medical and drug claims of a memberAny entity Contracting with the Prime Contractor to perform services or to fulfillany of the requirements requested in this RFP or any entity that is a subsidiary ofthe Prime Contractor that performs the services or fulfills the requirementsrequested in this RFPThe number of days from the date of service to the date of receipt that a providerhas to submit a claim before payment penalties are appliedThe person who is responsible for paying health plan premiums, or whoseemployment or group membership is the basis for eligibility for coverage under ahealth plan. For example, if a married couple has health insurance through thewife's employment, the wife would be the subscriber. The subscriber may also becalled the insuredDesignates the Head of Household ID (primary applicant)A response which provides sufficient information to the State, Department, orprovider so that the receiver of the response can determine that the Contractor ismaking a good faith best effort to respond to the inquiry in a timely manner.A component of a larger system that performs a specific function within thatlarger system. The component has within itself characteristics of a system but hasfunctional as well as structural relationships to other components of the coresystem. Examples would include the following parts (or subsystems) of anMMIS: Recipient, Reference, Provider, Claims, MARS, SURS, Third PartyLiability, and Managed Care.Paper billing containing the Medicare premium amounts due for a billing month14.14.2-32