Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130062. Provider Management (PM)YESwithoutYESwithReq #Description of Requirementcustomizationizationcustom-PM.243 National Council for Prescription Drug Programs (NCPDP)Xnumber - including historic data with effective and end datesPM.244 Employer Identification Number (EIN)/Taxpayer Identification XNumber (TIN) and effective and term datesPM.245 Social Security Number (SSN) XPM.246 Provider CLIA (Clinical Laboratory Improvement Amendments) Xnumber and related addressPM.247 Medicare numbers XPM.248 Managed Care Organization (MCO) affiliations XPM.249 Group number XPM.250 Specialty/sub-specialty data XPM.251 License and certification data XPM.252 Date of birth XPM.253 Date of death XPM.254 Gender XPM.255 Language XPM.256 Additional training or certification indicator XPM.257 Restrictions on dispensing of specific drugs XPM.258 Provider enrollment status codes with associated effective and Xend datesPM.259 Provider program eligibility with associated effective and end XdatesPM.260 Contractual terms, including: XPM.261 Services contracted to provide XPM.262 Performance measures (service level agreements and KPIs) XPM.263 Reimbursement rates XPM.264 Summary level payment data which is automatically updated afterXeach claims processing payment cycle by the following:PM.265 Calendar week-to-date XPM.266 Calendar month-to-date XPM.267 Calendar year-to-date XPM.268 State fiscal year-to-date XPM.269 Federal fiscal year-to-date XPM.270 1099 reported amount (current & prior year) XPM.271 Ownership date XPM.272 Physician Assured Access System (PAAS) indicator XPM.273 Fee-for-service (FFS) indicator XPM.274 Crossover indicator XPM.275 Suspended/Suspension indicator XPM.276 Suspended/Suspension effective and terminated dates XPM.277 Primary Care Case Management (PCCM) indicator XPM.278 Out-of-state Provider indicator XPM.279 Rural, urban, or teaching hospital indicator XPM.280 Electronic Funds Transfer (EFT) information XPM.281 Electronic Claims Management (ECM) data XPM.282 Billing restriction data, with applicable begin and end dates XPM.283 Medical degree information. XPM.284 Providers PCP panel information including: XNOunabletoprovide14.2-18