Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006Req #ME.56ME.57ME.58ME.59ME.60ME.61ME.62ME.631. Member Management (ME)Description of RequirementAbility to identify recipients with multiple ID numbers for crossreferencing, and for unduplicated counts of recipients for reportingpurposes.Ability to automatically or manually populate, maintain and displaymultiple (at a minimum 15) indicators at the Member level (e.g.,disease state management, TBI, MRDD).Enrollment broker can automate or be able to directly enterinformation that would be maintained in the Member record.Ability to allow enrollment brokers to enter Member choice (PCP orHMO) directly into the MMIS.Ability to allow enrollment brokers to enter notes, comments, etc.,into MMIS.The Vendor is expected to provide RAPIDS an interface containingHMO/PAAS assignments, TPL, and lock-in information 2-3 daysprior to the cut-off date to print on the Medicaid ID cards.Ability to automatically update and edit eligibility information basedon information received in Vital Statistics file.Ability to interface with the Department of Corrections to receiveincarceration file.YESwithoutcustomizationXME.64 Send data to RAPIDS for review of Member termination. XME.65 Provide an automated link to claims for the Member under current Xand historical names and ID numbers and display the data.ME.66 Ability to track and display all Member current and historical names Xand ID numbers.ME.67 Provide update capability for all Member data for designated BMS Xstaff and make update separate from inquiryME.68 Allow the user to inquire on Member benefit availability, servicelimitations, monetary limits, service utilization, and out-of-pocketcontributions such as co-pay, deductible, and coinsurance.XME.69 Allow direct navigation access to a Member's historical claims, PAs, Xreferrals, and case histories.ME.70 Ability to maintain current and historical eligibility data to support Xthe following:ME.71 Basic program eligibility verification XME.72 Special program eligibility verification XME.73 ID card production (currently the Fiscal Agent provides aninterface file that goes to RAPIDS and FACTS which containsMountain Health Trust, Mountain Health Choices, TPL, andLTC information).XME.74 Claims processing XME.75 Premium processing XME.76 Prior authorization processing XME.77 Reporting XME.78 Other activities as specified by the BMS during the DDI phase XXXXXXXXYESwithcustomizationNOunable toprovide14.2-5