Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006Req #ME.106ME.107ME.108ME.109ME.110ME.111ME.112ME.113ME.114ME.1151. Member Management (ME)Description of RequirementAbility to maintain accurate, date-sensitive SSN information forfoster and adopted children whose SSNs are changed by SSA whileprotecting confidential client information. (This is date-sensitiveSSN information regarding Foster and Adopted Children. FiscalAgent should be able to maintain all claim history for a membereven if his SSN is changed).Ability to capture and restrict user access to the actual residentialaddress information, including Zip Codes, for protected populations,in addition to publicly disclosed residential addresses.Ability to maintain and report Member and other data in order torespond to a request from a Member for an accounting of disclosuresof his/her Protected Health Information (PHI), in accordance withHIPAA guidelines.4. Inquire Member EligibilityThe Vendor is expected to maintain a Medicaid EligibilityVerification System (MEVS).The Vendor is expected to provide each Medicaid EligibilityVerification System (MEVS) vendor daily access to approvedMember eligibility data.The Vendor is expected to provide an Automated Voice ResponseSystem (AVRS) which accesses the MEVS information.The system is expected to provide web portal eligibility verificationwith at least the same functionality as that which is available viaAVRS.Ability to electronically generate eligibility verification reportsbased on supplied list (there may be an associated cost to theprovider).The system should maintain a log of all telephone and electronicinquiries to eligibility inquiry systems.YESwithoutcustomizationXME.116 5. Perform Population & Member OutreachME.117 Ability to track Member outreach communications detail, including: XME.118 Target population XME.119 Quality measure/s addressed XME.120Purpose (e.g., implement programs like enrollment campaignsfor waiver programs or other plan/benefits change, privacynotice)ME.121 Date/s of distribution XME.122 Method/s of distribution XME.123 Other as identified by BMS during DDI and accepted via formal Xchange controlME.124 6. Manage Applicant & Member CommunicationME.125 Ability to generate and distribute Member-related correspondence, Xreports and associated documents.ME.126 Ability to attach Member-related correspondence documents to the XMember record.ME.127 Periodically generates Member satisfaction surveys. XME.128 The system is expected to receive and track summary level mailingdata from the enrollment broker for reporting purposes.XXXXXXXXXYESwithcustomizationXNOunable toprovide14.2-7