Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130063. Operations Management (OM)OM1. Service AuthorizationYESwithoutReq #Description of RequirementcustomizationOM1.84 Identifies and displays the user, date, and time entered XOM1.85 Provides the capability to display free form narrative inXchronological or reverse chronological sequenceOM1.86 Ability to accommodate flexible time span dates for PA (byXcalendar month, calendar year, rolling month, and other as definedby BMS).OM1.87 Ability to apply the method and hierarchy of PA processing criteria Xas defined by BMS.OM1.88 Ability to automatically approve certain PA requests based on Xinformation entered (as identified by BMS).OM1.89 Ability to perform comprehensive on-line and batch edits to ensure Xthe integrity of prior authorization data.OM1.90 Ability to run edits on submitted PA requests, such as theXfollowing:OM1.91 Relationship edits XOM1.92 Field length/type XOM1.93 Character type XOM1.94 Ability to edit PAs on-line for the presence of required data to Xinclude:OM1.95 Valid Provider ID and eligibility XOM1.96 Valid procedure and diagnosis codes XOM1.97 Presence of required claim type-specific data on the PA XOM1.98 Covered service XOM1.99 Allowed dollar amounts/unit XOM1.100 Other as identified by BMS during DDI and accepted viaXOM1.101formal change controlAbility to automatically alert Providers of the need for additionalinformation (e.g., HIPAA 278 transaction, pdfs), providing returnmessages that clearly describe necessary action.XYESwithcustomizationOM1.102 Ability to reject PA request if it does not pass all edits. XOM1.103 Ability to automatically notify the submitter of failed PAXsubmission and identify which field(s) did not pass edits.OM1.104 Ability to automatically generate Provider alerts and notifications, Xto include:OM1.105 The need for additional information on an already submitted XPA requestOM1.106 Reminders of missing information XOM1.107 System updates/policy changes XOM1.108 Duplicate or possible duplicate requests XOM1.109Ability to automatically notify users of duplicate or possibleduplicate PA requests for on-line PAs as well as PAs submitted viathe interface files.OM1.110 Ability to identify and reject duplicate PAs across all PA types Xbased on user configurable criteria including:OM1.111 Client identifier XOM1.112 Rendering Provider identifier XOM1.113 Service from and through dates XOM1.114 Diagnosis code(s) XXNOunable toprovide14.2-24