Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsBE Member Management Requirements - MMIS A B C D EBE1.SS.08BE1.SS.09BE1.SS.10BE1.SS.11BE1.SS.12BE1.SS.13BE1.SS.14BE1.SS.15BE1.SS.16BE1.SS.17BE1.SS.18BE2.01BE2.01.01BE2.01.02a. Effective dates.b. Termination dates.c. Medicare identification number.d. Medicare advantage plan information.e. Part D coverage.f. Other health plan information.g. Medicare buy-in information.h. Part C coverage.i. Other information as defined by IME.Provide a monthly extract of members that are dually eligible forMedicare and Medicaid, to the Medicare Part A, Part B and Part Dcarriers, or coordination of benefits carrier and CMS.Provide the capability to periodically archive member records usingcriteria approved by IME.Provide the capability to void and retain member information asdetermined by IME.Provide the capability to perform reconciliation of the member modulewith 100% accuracy, approved by IME to all eligibility files in theeligibility system on a schedule to be determined by IME.Provide the capability to generate Medicare eligibility files for theMedicare claims processor to use in processing crossover claims.Provide address type and effective dates for each address maintained inthe member management module. Provide the capability to select thetype of address when mailings are prepared for members, exampleThird-Party Liability (TPL), Explanation of Medical Benefits (EOMBs),EPSDT letters and prior authorization determinations.Provide a robust search capability in the member database usingminimal steps and keystrokes to search for all available member dataelements.Provide the capability to view a single eligibility episode that iscomprised of multiple eligibility segments for example see “the beginningand end date” for all contiguous eligibility segments.Provide the capability to accept and send data using various mediaoptions such as, online, Internet Direct Data Entry (DDE), ElectronicData Interchange (EDI) and reports to other state agencies and otherexternal sources, in the format required by IME.Provide the capability to provide authorized staff with real-time access toall modules of the MMIS, for inquiries during normal business hours.Provide the capability to identify the name(s) of the provider(s) to whichthe member is locked-in.Provide data storage and retrieval for TPL information; support TPLprocessing and update of the information.Support the assignment of members to benefit plans based on rules inthe rules engine and provide the capability to set the effective date ofenrollment in a Benefit Plan on the date of enrollment, a default date orany state defined date.Provide the capability to determine if a member is enrolled in multiplebenefit plans for example HCBS, Medically Needy, PG (Pregnancy),ICF-MR, QMB and SLMB. Provide the capability to distinguish whichbenefit plan will fund the service based on the hierarchy as establishedby IME.Yes No SM 75Yes No SM 120Yes No SM 100Yes No SM 140YesYesYesYesYesYesYesYesYes No SM 200YesYesYesYesYesYesYes No SM 150YesYesSection 9.1.1.1.2,Requirement #BE1.SS.08Section 9.1.1.1.2,Requirement #BE1.SS.09Section 9.1.1.1.2,Requirement #BE1.SS.10Section 9.1.1.1.2,Requirement #BE1.SS.11Section 9.1.1.1.2,Requirement #BE1.SS.12Section 9.1.1.1.2,Requirement #BE1.SS.13Section 9.1.1.1.2,Requirement #BE1.SS.14Section 9.1.1.1.2,Requirement #BE1.SS.15Section 9.1.1.1.2,Requirement #BE1.SS.16Section 9.1.1.1.2,Requirement #BE1.SS.17Section 9.1.1.1.2,Requirement #BE1.SS.18Section 9.1.1.1.2,Requirement #BE2.01Section 9.1.1.1.2,Requirement #BE2.01.01Section 9.1.1.1.2,Requirement #BE2.01.029.1.1.1 | 4