Molina Medicaid Solutions - DHHR

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Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130063. Operations Management (OM)OM1. Service AuthorizationYESwithoutReq #Description of RequirementcustomizationOM1.168 Template development and the ability for users to select desired Xcorrespondence from a list of available templatesOM1.169 Display, print, and save PA-related correspondence via the XEDMS component of the MMISOM1.170 Regenerate correspondence XOM1.171 Allow users to suppress or allow auto generation ofXcorrespondence based on user configurable event-drivencriteriaOM1.172 Allow users to insert and override address information on XcorrespondenceOM1.173 Allow users to add free form text to individual or groups of PA XcorrespondenceOM1.174 Other as identified by BMS during DDI and accepted viaXformal change controlOM1.175 Ability to automatically alert staff via email thatXletters/notifications have been generated.YESwithcustomizationNOunable toprovide14.2-28
Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130063. Operations Management (OM)OM2. Payment Management, Claims/Encounter AdjudicationYESwithoutReq #Description of RequirementcustomizationOM2.1 1. Claims ProcessingOM2.2 Ability to provide and maintain a claims processing component Xwith the capability to process electronic and paper transactions.OM2.3 Ability to perform real-time adjudication of claims. XOM2.4 Ability to process all standard claim types, including: XOM2.5 Institutional (UB-04, 837-I) XOM2.6 Professional (CMS-1500, 837-P) XOM2.7 Dental (ADA, 837-D) XOM2.8 Pharmacy (NCPDP current and future versions (electronic) or XUniversal claim form (paper))OM2.9 Ability to provide a Claims Processing component that offers the Xfollowing functionality:OM2.10 Claim Entry and Editing XOM2.11 Claim Auditing XOM2.12 Claims Inquiry XOM2.13 Claims Tracking XOM2.14 Batch Control (Batch Control is used for paper claims.XCurrently these are batches of 50 claims. A report is alsoproduced as these claims are sent to a keying organization. TheBatch Control report verifies that all claims in a batch areaccounted for).OM2.15 Quality Control XOM2.16 Pricing XOM2.17 Claim Output (Claim Output would be used in interface files or Xin reporting. The formats of Claim Output would be discussedin DDI).OM2.18 Suspense (pend) Correction XOM2.19 Interface with POS system XOM2.20 Third Party Liability XOM2.21 Month-End Processing XOM2.22 1099 Adjustments XOM2.23 Claims History File XOM2.24 Attachments XOM2.25 Claim Forms XOM2.26 Automated procedure code editing which allows acceptance of Xnationally recognized modifiersOM2.27 Claim Disposition (for all claim types, according to BMS and XFederal processing rules)OM2.28 Electronic Media Claims XOM2.29 Claim Payment XOM2.30 Accounts Payable Management XOM2.31 Accounts Receivable Management XOM2.32 Provider Credits and Adjustments Processing XOM2.33 Explanation of Medical Benefits (EOMB) Processing XOM2.34 Diagnosis Related Group (DRG) Processing XOM2.35 Resource Based Relative Value Scale (RBRVS) Processing XOM2.36 APC (Ambulatory Patient Classification) Processing (OPPS, Xout-patient prospective processing system)YESwithcustomizationNOunabletoprovide14.2-29
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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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