Molina Medicaid Solutions - DHHR

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Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130061. Member Management (ME)YESwithoutReq #Description of RequirementcustomizationME.129 7. Manage Member Grievance & AppealME.130 Ability to track PA denials in MMIS. XME.131 Provide the ability for BMS to manually flag denied priorXauthorizations under appeal.ME.132 Provide the ability for BMS to run a report of all denied priorXauthorizations flagged as under appeal.ME.133 Provide the ability for BMS to display a report of all denied prior Xauthorizations flagged as under appeal.ME.134 The system should support workflow for the appeals and grievances Xprocesses.ME.135 The system should employ the use of a control mechanism which Xautomatically assigns unique control numbers to monitor, track, andmaintain control over all consumer review cases.YESwithcustomizationNOunable toprovide14.2-8
Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130062. Provider Management (PM)YESwithoutReq #Description of RequirementcustomizationPM.1 1. Enroll ProviderPM.2 Ability to enroll Providers eligible to provide Medicaid services. XPM.3 Ability to enroll non-traditional Medicaid Providers to supportXpayment of services in the MMIS. For example, taxi/transportationand respite.PM.4 Ability to enroll non-Medicaid Providers on behalf of differentXprogram or different agency or others as defined by BMS andaccepted via formal change control. (No other entities identified atthis time, but the Vendor’s system is expected to be flexible, scalable,and capable of supporting others).PM.5 The Vendor is expected to maintain control over all data pertaining to XProvider enrollment (including paper batches and electronic data).PM.6 Ability to generate unique tracking numbers for Provider enrollment Xapplications and updates.PM.7 Ability to give Providers secure temporary access to the enrollment Xprocess and once approved for enrollment, permanent access to theonline system.PM.8 The system should allow Providers the ability to complete and submit Xenrollment applications and updates in a secure online environment.PM.9 Ability to automatically assign Providers a temporaryXusername/password for the online enrollment process.PM.10 Ability to automatically generate to the submitter a receiptXnotification with a tracking number when an online application and/orupdate are submitted for review.PM.11 Ability to notify Provider that an online update has been received, but Xrequires validation before it becomes effective. (Any update providerwould submit. Addition of Medicare number, new address, newcertification, etc.).PM.12 Ability to allow Providers to access their own information and group Xowners to access information for all Providers in the group.PM.13 Ability to allow Providers access (with appropriate level of security) Xto retrieve the status of online applications and updates using theirapplication tracking number.PM.14 Online screens should provide alternative contact information (e.g. Xtelephone access number, help desk number) for use in case ofquestions or technical issues.PM.15 Ability to allow Providers to view and send online alerts andXPM.16PM.17PM.18notifications generated by BMS or Vendor staff.The Vendor is to notify Providers of acceptance/rejection as a WestVirginia Medicaid Provider (per BMS specifications regardingnotification medium and content).Ability to route online applications and updates to the appropriatestaff to work. Configuration of workflow to be defined by BMSduring DDI.Ability to alert appropriate staff that a Provider enrollmentapplication has pended for a certain amount of days as defined byBMS.XXXYESwithcustomizationNOunabletoprovide14.2-9
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Molina Medicaid SolutionsResponse t
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e10vkTable of ContentsItem 1:Overvi
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e10vkDepartment of Health Services
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e10vkservices, and reputation or na
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e10vkIf our government contracts ar
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e10vkIf our cost increases resultin
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e10vkour board of directors. Becaus
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e10vkFirst Quarter $ 44.94 $ 23.46S
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e10vkTable of ContentsCertain compo
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e10vkNevada 8,037 1,106.45 9,099 1,
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e10vkInvestment IncomeInvestment in
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e10vkand 2007, respectively. EBITDA
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e10vk$2.8 million, or $0.10 per dil
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e10vkREPORT OF INDEPENDENT REGISTER
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e10vk65Table of ContentsMOLINA HEAL
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e10vkDelegated Provider InsolvencyC
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e10vk2007 (see Note 11, “Long-Ter
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e10vk$ 252,380 $ 248,039Gross reali
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e10vkTable of ContentsMOLINA HEALTH
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e10vk$10.9 million, and $7.9 millio
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e10vkIn July 2008, our board of dir
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e10vkThe Registrant has an equity i
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e10vkSIGNATURESPursuant to the requ
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exv12w1EX-12.1 2 a51362exv12w1.htm
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e10vkEX-31.1EX-31.2EX-32.1EX-32.2Ta
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e10vkLeverage operational efficienc
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e10vkhealth plans. Among such facto
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e10vkMissouri and Ohio health plans
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e10vkWe are subject to various rout
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e10vkIt may be difficult for a thir
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e10vkItem 5:PART IIMarket for Regis
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e10vkstates to exclude certain bene
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e10vkMedical care ratio 86.8% 84.8%
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e10vkTable of ContentsMedical care
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e10vkare required to pay a fee for
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e10vkknown. While we believe our cu
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e10vkYear Ended December 31,2009 20
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e10vkCalifornia $ 481,717 $ 417,027
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e10vkMOLINA HEALTHCARE, INC.NOTES T
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e10vk2008, we had transitioned fewe
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e10vknot intend to sell, nor is it
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e10vkDuring 2009, 2008, and 2007, t
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e10vk$29.17 - $30.05 9,350 5.9 $ 29
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e10vk(1) The Registrant’s condens
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e10vkChanges in Internal Controls:
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e10vkSignature Title Date/s/ Joseph
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exv10w22Commitments exceed the sum
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exv10w22Loan Document. The amendmen
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exv10w22Name:Title:Fifth Amendment
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exv10w22Fifth Amendment to Credit A
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exv10w24EX-10.24 3 a55407exv10w24.h
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exv10w24Molina ECMS ref# 729 Provid
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exv10w24HSA — Hospital Services A
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exv10w243.2 Member Eligibility Dete
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exv10w245.6 Amendment. Health Plan
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exv10w24HSA — Hospital Services A
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exv10w24License No. StreetNPI (or U
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exv10w24Page 23 of 40ATTACHMENT CPr
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exv10w24• This reimbursement meth
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exv10w24(Rule 53250(e)(4))8. Provid
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exv10w241. Right to Audit. Provider
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exv10w24Treasurer G. William Hammer
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exv10w25unless the situation is one
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exv10w25Plan in identifying, proces
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exv10w25Page 9that the offset and r
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exv10w25under this Agreement.h. Hea
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exv10w25Page 16Date 6/1/06ATTACHMEN
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exv10w25that Provider is de-delegat
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exv10w25the subscriber or Member by
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exv10w25discretion, that Provider h
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exv10w252.5 Annual Disclosure of Ca
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exv10w25Initials of authorizedrepre
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exv10w25the report is true and corr
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e10vk10-K 1 a58840e10vk.htm FORM 10
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e10vkOur StrengthsWe focus on servi
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e10vkevent.CompetitionWe operate in
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e10vkat the funding for these healt
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e10vk18Table of ContentsAlso, many
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e10vkTable of Contentsalleged non-c
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e10vk(fair value of $20.4 million).
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e10vkTable of ContentsSTOCK PERFORM
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e10vkAs of December 31, 2010, our h
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e10vkYear Ended December 31,2010 20
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e10vkAcquisitionsWisconsin Health P
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e10vkspecific performance measures
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e10vkoverestimations were tied to o
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e10vkIntangible assets, net 105,500
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e10vkOur Health Plans segment compr
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e10vkSituations may arise where the
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e10vkinvestment fund. As of Decembe
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e10vk7. ReceivablesHealth Plans seg
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e10vkindebtedness under the Credit
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e10vkstatutory capital and surplus
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e10vkCash paid in business purchase
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e10vkItem 12.Security Ownership of
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exv10w27EX-10.27 2 a58840exv10w27.h
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exv10w27(f) all transferable or ass
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exv10w27and other charges have been
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exv10w27under or affecting the Prop
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exv10w27BY A GENERAL RELEASE, WHICH
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exv10w27(f) Seller’s share of the
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exv10w2710.6 Items Not to be Prorat
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exv10w27- 21 -(i) Delinquency Repor
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exv10w27executed, and delivered by
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exv10w27MATERIALS THAT PERTAIN TO T
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exv10w27Attn: General CounselTeleph
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exv10w2718.16 Authority. The indivi
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Molina Medicaid Solutions - DHHR

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