Q: I understand that the new Medicaid Management Information System
(MMIS) will pay
providers currently paid via an A-19. How long will it take to get rid
of all the A-19’s?
A: The current Implementation Plan takes us out
until 2010. At that time all A-19’s within the scope of
ProviderOne will be incorporated into automated processes.
Q: It appears that it will take providers a
while to get used to the new system. How will that be addressed?
A: Provider training will be offered through a
number of mechanisms including regional training sessions, on-line
tutorials and live web training. There will also be additional call
center staff on hand to handle the expected increase in calls during the
first few months of operation.
Q: Why can’t states maintain their own MMIS?
A: Many states do operate their own MMIS. However,
it’s difficult for states to acquire the technical resources to keep
systems updated to reflect current federal and state policy. Vendors
also have the advantage of leveraging costs and resources across
multiple states, therefore keeping operations and maintenance costs
down.
Q: Has the federal Centers for Medicare and
Medicaid Services (CMS) published any national business rules
or system specifications?
A: The system must meet the CMS certification
requirements outlined in the State Medicaid Manual. Other than that,
there are no specific business rules or system specifications published
by CMS.
Q: Does the federal Centers for Medicare and
Medicaid Services (CMS) require data from all states that is
compiled into national reports? If so, it wouldn’t be standardized since
each state operates their own system, correct?
A: There is required reporting to CMS that is
consistent from state to state. CMS uses this data to report on
national trends.
Q: The scope of ProviderOne includes
non-medical services. Will ProviderOne be able to pay for these types
of services?
A: Yes, there are many Medicaid clients who receive
non-medical services. The new system will be designed to pay for all
types of services provided to Medicaid clients. In addition, programs
that use similar payment processes for non-Medicaid clients will also
have those services paid from ProviderOne.
Q: Will DSHS be including a Pharmacy Point of
Sale system as part of this procurement?
A: Yes. The Pharmacy Point of Sale system is the first
implementation.
Q: Will DSHS be including a Data Warehouse and
Decision Support System as part of this
procurement?
A: A Data Warehouse will be part of this procurement as well
as data and reports to support the Executive Information System, Management
and Administrative Reporting System, and Surveillance, Utilization and
Review System
requirements. Fraud and Abuse Detection algorithms and
models are outside the scope of this procurement.
