Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130061. Member Management (ME)YESwithoutReq #Description of RequirementcustomizationME.19 2. Enroll/Disenroll MemberME.20 Capture, retain and report in a roster enrollee choice of provider. It Xcan be either the MCO or the PAAS PCP.ME.21 Enrollment broker is to have direct (role-based) user-access to the XMMIS. (The enrollment broker enters PCP information for theHealth Maintenance Organization (HMO) and the Primary CareCase Management (PCCM) program).ME.22 The Vendor is to maintain appropriate benefits package for services Xfor enrolled Member.ME.23 Ability to support flexible administration of benefits from multiple Xprograms so that a Member may receive a customized set ofservices.ME.24 Ability to report on duplicate Member records using multiple criteria X(e.g., name, SSN) in order to reconcile duplicate enrollment records.ME.25 Ability to capture and display from eligibility source head-ofhouseholdXname. (These pieces of information are currently stored inthe member record and do not vary by benefit plan or payor).ME.26 Capture and display case number in each individual Member record. XME.27 Ability to track and display on one screen: all Members in the case,including individual Members name under that case number;Medicaid ID number; date of birth; PCP/HMO name; and benefitprogram.ME.28 Ability to store, track and display eligibility source data including Xbut not limited to eligibility codes, termination reason codes,termination dates, etc.ME.29 Generate monthly PAAS rosters to be submitted to the PAASXproviders monthly.ME.30ME.31ME.323. Manage Member InformationCapture the Health Improvement Plan (HIP) from the enrollmentbroker. Generate monthly file to all parties as necessary (e.g., MCOAdmin Vendor and MCOs). (The Health Improvement Plan (HIP) isa plan the member must complete with their physician and agree tocomplete specific health related activities in order to earn healthyrewards. This information is currently sent on a file to the MMISvendor and loaded into the system).Ability to accept electronic updates of the Member eligibility data(including updates to existing Member data and creation of newMember records) on a daily basis via batch file from the following orequivalent external systems:ME.33 RAPIDS (Recipient Automated Payment and Information Data XSystem)ME.34 FACTS (Families and Children Tracking System) XME.35 TPL vendor/s as specified by BMS (the Bureau currently only Xreceives TPL information from one vendor).ME.36 Enrollment broker/s as specified by BMS XME.37 Other systems as specified by the BMS during DDI XME.38 Ability to support the following functionality in regards toprocessing updates to the Member data set:XXXYESwithcustomizationXNOunable toprovide14.2-3