Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006TERMUNC NameUnduplicated(Eligible/Recipient)Universal Claim FormUSCUserUser Acceptance TestingUsual and Customary FeeScheduleUtilization ReviewValidateVariable Per DiemVendorVendor Buy LocViolation TimeVoidWaiverWANWarrantWhisperWithholdWork Breakdown Structurefor a memberUniversal Naming ConventionDEFINITIONAn unduplicated eligible/recipient is a uniquely counted eligible/recipient who iscounted only once during a given period for any particular category of interest.The NCPDP standard paper claim form for pharmacy claimsUnited States CodeAny individual or a group identified by the State as the persons authorized to useall or parts of MMIS/PBM/DSS functions.This is the last phase of testing in the MMIS and will be conducted with a crosssection of end users testing the applications. The end users will use real worldscenarios and perceptions relevant to their daily work.The file containing the reasonable charges of a given procedure to be reimbursedto a practitioner. The reasonable charge can vary according to different regions inthe State.The process of monitoring and controlling the quantity and quality of health careservices delivered under Medicaid Program.VSupport or corroborate on a sound or authoritative basisAllows reimbursement in different amounts, based on the length of stay forinpatient services. The start day, end day, and amount of each variable per diemare specifiedAny responsible source that provides a supply or serviceVendor Buying Location, defines source of an AP invoice including the pay-toprovider’s associated 1099 informationGoal set for the amount of time a call center interaction remains in the queue;interactions remaining longer than the goal are considered inA transaction which has the effect of zeroing out the payment amount of apreviously paid claim.WAn exception requested of or granted by CMS in response to a request from astate, usually regarding some required aspect of Medicaid regulations in order toimplement a new program or system.Wide Area NetworkA record of an actual payment mechanism, such as a paper check or electronicfunds transfer; e.g., the warrant number of paper check is the number printed onthe checkOption of the call center customer service representative to communicate with thecall center supervisor without the Health PAS-OnLine user being aware of thecommunicationPercentage of the capitation or fee for service payment from each service that isretained by the health plan to finance potential deficits if health plan premiumsfrom enrollees are less than health plan payments to physiciansA detailed plan used to complete and track a project. The WBS identifies everytask in the project, estimates time and resource requirements, identifiespredecessor and successor tasks, identifies the critical path, and is used to compareto actual project performance14.14.2-35