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 EBE2.01.03BE2.01.04BE2.01.05BE2.02BE2.02.01BE2.02.02BE2.02.03BE2.02.04BE2.03Support a universal identifier for members across all benefit plans andcross-reference that identifier with all prior established benefit planidentifiers.Maintain the benefit package associated with each benefit plan,including the rules that apply to provider enrollment, claims processing,reporting and any other processing rules.Provide the capability to maintain insurance coverage data in themember management module including, but not limited to:a. Carrier.b. Policy number.c. Group number.d. Pharmacy Benefit Manager (PBM) ID and member identificationnumber.e. Sponsor, subscriber or policy holder name and identificationnumber(s).f. Type(s) of coverage.g. Dates of coverage.h. Date the coverage was added to the database.i. Date the coverage was updated.j. Court order including date ranges and responsible payer.k. Part D enrollment indicator - The record should indicate the member isenrolled in Medicare Part D and identify the plan the member is enrolled.l. Allow for multiple insurance policies.Supports the assignment of members to Medicaid benefits and benefitpackages based on federal and or IME-specific eligibility criteria.Provide the capability to maintain a historical record of benefitassignment(s) for a member, including identifying dual-eligibility spans.Provide the capability to create new benefit plans by configuring throughthe rules engine using a defined process for testing and promotingchanges.Provide the capability to create new benefit plans by a business analystwithout involvement of programmers.Provide the capability to maintain a historical record of benefitassignment(s) for a member, including identifying dual-eligibility spans.Apply appropriate benefit limitations for members based on federal andor IME-specific criteria.BE2.04 Maintain record of member benefit limitation information. Yes YesBE2.05BE2.06BE2.07BE2.SS.01BE2.SS.02Calculate and apply member cost-sharing, including premiums and copays,for particular benefits based on federal and or IME-specific criteria.Maintain record of member cost-sharing and provide the capability toretain "to date" accumulations for cost sharing if a member movesbetween benefit plans.Maintain record audit trail of any notice of benefit(s) sent to membersincluding time and date, user source and reason for notice.Provide the capability of real time updates to the member module asdirected by IME.Provide the capability to perform mass re-assignment of members priorto the end of the month or on an as needed basis.YesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesSection 9.1.1.1.2,Requirement #BE2.01.03Section 9.1.1.1.2,Requirement #BE2.01.04Section 9.1.1.1.2,Requirement #BE2.01.05Section 9.1.1.1.2,Requirement #BE2.02Section 9.1.1.1.2,Requirement #BE2.02.01Section 9.1.1.1.2,Requirement #BE2.02.02Section 9.1.1.1.2,Requirement #BE2.02.03Section 9.1.1.1.2,Requirement #BE2.02.04Section 9.1.1.1.2,Requirement #BE2.03Section 9.1.1.1.2,Requirement #BE2.04Section 9.1.1.1.2,Requirement #BE2.05Section 9.1.1.1.2,Requirement #BE2.06Section 9.1.1.1.2,Requirement #BE2.07Section 9.1.1.1.2,Requirement #BE2.SS.01Section 9.1.1.1.2,Requirement #BE2.SS.029.1.1.1 | 5