Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130062. Provider Management (PM)YESwithoutReq #Description of RequirementcustomizationPM.64 3. Disenroll ProviderPM.65 Ability to allow Providers to submit online request for termination of Xtheir Provider agreement.PM.66 Ability to identify Provider disenrollment request status, as defined Xby BMS (e.g., initial, duplicate, resubmitted with modifications).PM.67 Ability to validate that disenrollment meets State rules, as defined by Xthe BMS.PM.68 Ability to allow users with appropriate authorization to terminate Xproviders.PM.69 Ability to process disenrollment requests for the full range ofXProvider types, organizations, specialties, types of applicants (e.g.,primary Provider, billing agent, pay-to entity).PM.70 Ability to process disenrollment requests for all application status Xtypes (e.g., Initial/New, Modification, Cancellation, Update).PM.71 Ability to disenroll Providers after a certain period of inactivity (to be Xdefined by BMS).PM.72 Ability to distribute notifications of disenrollment due to sanctions or Xdisciplinary actions to the WV Office of the Inspector General (OIG)and other states.PM.73 4. Inquire Provider InformationPM.74 The Vendor is expected to accommodate Provider enrollmentXverification requests via phone, fax, portal, and other methods (asspecified by BMS during DDI and accepted via formal changecontrol).PM.75 Ability to log and track all Provider information requests, including: XPM.76 Name of requesting party XPM.77 Date of inquiry XPM.78 Parameters used in system query XPM.79 User name (of user querying system) XPM.80 Validation of Authorization detail XPM.81 Date/time information queried in system XPM.82 Date/time information sent to requester XPM.83 Other as identified by BMS during DDI and accepted via formal Xchange controlPM.84 Ability to support entry of free-form text field that allows narratives X(of a length defined by the BMS) for each Provider informationinquiry. Each entry is expected to include identification of user anddate/time entered.PM.85 Ability to display free-form narrative in chronological or reverse Xchronological sequence.PM.86 5. Manage Provider CommunicationPM.87 Ability to generate and distribute Provider-related correspondence, Xinformation requests, and notifications, including:PM.88 Enrollment applications XPM.89 Enrollment rejection notifications XPM.90 Billing instructions XPM.91 Relevant State policy information XPM.92 Request for information to support enrollment/contracting process XPM.93 Mailing labels XYESwithcustomizationNOunabletoprovide14.2-12