Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsPR Provider Management Requirements - MMIS A B C D EPR2.07.01PR2.SS.01Provide the capability to store and maintain provider rates includinghistorical rates and date changes.Maintain the capability to limit billing and providers to certain benefitplans, services, by procedure codes, ranges of procedure codes,member age or by provider type(s) or as otherwise directed by IME.PR2.SS.02 Provide data elements to capture provider contact information. Yes YesPR2.SS.03 Provide online view of all provider specific rates. Yes YesPR2.SS.04 A data element must exist to capture the facility bed size. Yes YesPR2.SS.05PR2.SS.06PR2.SS.07PR2.SS.08Ensure all end dates are linked, so they can be synchronized to the enddate of the licenses of the state of servicing location or other licenses asdirected by IME.Provide a mechanism to identify provider types not required to have alicense.Ensure the billing provider is enrolled and has a provider number.Individual practitioners associated with the billing provider will be linkedto the billing provider ID.Support automated criminal background checks for all providers asspecified by IME.PR2.SS.09 Store geographic codes for provider locations. Yes No SM 200PR2.SS.10PR3.01PR3.01.01PR3.02Enable different provider enrollment rule definitions by provider, providertype, program, geographic area and other areas, as defined by IME.Accept, validate and process transactions or user entries to update andmaintain provider information.Provide for the collection and maintenance of additional data in theprovider database, including, but not limited to:a. Sanction information.b. Accreditation information.c. Provider links to Taxpayer Identification Number (TIN) and parentorganizations.d. Inactive and active filter.e. Care management and or lock-in restrictions.f. Case load assignments.g. License number and licensure status.h. Pay for performance (P4P) indicator.i. Restrictions for payments (no payment for surgeries).j. Flag for Electronic Funds Transfer (EFT) information.k. Flag for electronic claim submission.l. Drug Enforcement Administration (DEA).m. County.n. Email contact information.Provide user access to provider data and allow extraction of information.The extracts or reports could include such items as:a. The current status of providers records.b. An alphabetical provider listing.c. A numeric provider listing.d. A provider rate table listing.e. An annual re-certification notice.YesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYes No SM 100Section 9.1.2.1.2,Requirement #PR2.07.01Section 9.1.2.1.2,Requirement #PR2.SS.01Section 9.1.2.1.2,Requirement #PR2.SS.02Section 9.1.2.1.2,Requirement #PR2.SS.03Section 9.1.2.1.2,Requirement #PR2.SS.04Section 9.1.2.1.2,Requirement #PR2.SS.05Section 9.1.2.1.2,Requirement #PR2.SS.06Section 9.1.2.1.2,Requirement #PR2.SS.07Section 9.1.2.1.2,Requirement #PR2.SS.08Section 9.1.2.1.2,Requirement #PR2.SS.09Section 9.1.2.1.2,Requirement #PR2.SS.10Section 9.1.2.1.2,Requirement #PR3.01Section 9.1.2.1.2,Requirement #PR3.01.01Section 9.1.2.1.2,Requirement #PR3.029.1.2.1 | 4