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 EPR.SS.09PR.SS.10Provide the capability to identify the entity that holds a lien against theprovider if applicable, total lien amount, periodic payment amountswithheld, cumulative payment amounts withheld, and lien balance.Provide the capability to produce alphabetic and numeric provider listswith totals and subtotals that can be restricted by selection parameterssuch as provider type, provider specialty, county, zip code andenrollment status.PR.SS.11 Provide capability to provide data required for rate setting. Yes YesPR.SS.12PR.SS.13PR.SS.14PR.SS.15PR.SS.16PR.SS.17PR.SS.18PR.SS.19PR.SS.20Provide the capability to update licensure data based on electronic filesfrom occupational licensing entities.Synchronize data with statewide provider directory Health InformationExchange (HIE) and licensing boards.Accept and upload enrollment information, including NPI if required onproviders from external source.Accept and upload rate information from external sources including excelspreadsheets.Provide the capability to identify providers whose licenses, certifications,provider agreements and permits are set to expire ninety (90) days priorto the end date of current certification, licensing or permit period andnotify the contractor of the pending expiration.Perform automated checks of national databases and bulletin boards forexclusions, sanctions or license revocation in other states or by CMS.Identify providers that have a foreign mailing address and provide thecapability to not send payment to a foreign mailing address.Provide the functionality to allow multiple provider status codes to bevalid for the same or overlapping timeframes.Process and maintain inputs and outputs including but not limited to thefollowing:Inputs:a. Provider enrollment data.b. Provider demographic changes.c. Provider rate changes.d. State and federal licensing and certification documentation.e. Provider sanction listings.Outputs:a. Daily, monthly and on request reports and address labels.b. Daily provider files.c. Produce and deliver to the IME all reports requested by the IME fromthe provider data maintenance function, at the specified frequency,medium and delivery destination.d. Remittance advices in electronic format and X12N 835.e. Annual 1099s, on federally approved forms and mail to providers.f. Group mailings and provider labels based on selection parameterssuch as provider type, zip code, specialty, county and special programparticipation.g. Report identifying any providers who have changed practicearrangements (e.g., from group to individual of from one business toanother) by provider type as requested by the IME.h. Data required for rate setting as required by IME.YesYesYes No SM 150Yes No SM 600Yes No SM 200YesYesYesYesYesYesYes No SM 400Yes No SM 25YesYesYesYesSection 9.1.2.1.2,Requirement #PR.SS.09Section 9.1.2.1.2,Requirement #PR.SS.10Section 9.1.2.1.2,Requirement #PR.SS.11Section 9.1.2.1.2,Requirement #PR.SS.12Section 9.1.2.1.2,Requirement #PR.SS.13Section 9.1.2.1.2,Requirement #PR.SS.14Section 9.1.2.1.2,Requirement #PR.SS.15Section 9.1.2.1.2,Requirement #PR.SS.16Section 9.1.2.1.2,Requirement #PR.SS.17Section 9.1.2.1.2,Requirement #PR.SS.18Section 9.1.2.1.2,Requirement #PR.SS.19Section 9.1.2.1.2,Requirement #PR.SS.209.1.2.1 | 7