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State of Mississippi, Division of Medicaid
Request for Proposals #20131025
MS MES and Fiscal Agent Services
Agree to Alternate Proposal
REFERENCE REQUIREMENT Meet as Process Reference
Stated Proposed
CONTRACT MANAGEMENT
Contract Management (OCM)
Provide an automated project tracking and control system
to track operational performance and monitor operational
OCMSS01 activities. The automated tracking and control system shall
be the repository for inventories of work done and work to
be completed, and will include all areas of Fiscal Agent
services, including subcontracts and EDI.
Provide operational activity and performance reports,
accessible and updatable online by DOM and Fiscal Agent
management staff. These activity reports must be in a
OCMSS02 downloadable format compatible with standard desktop
applications for data manipulation, such as Excel or Access.
The automated tracking with production reports must
comply with the performance standards in this RFP.
Provide an automated performance monitoring system to
produce the “report card” on Fiscal Agent performance,
OCMSS03 including reporting that is accessible online by DOM and
Fiscal Agent management staff. The scope, format,
content, measure criteria, and standards used in the report
card must be approved by DOM.
Provide monthly management summary reports to DOM,
OCMSS04 accessible online, to report on the overall status of the
project, including, but not limited to, the following
minimum expectations:
OCMSS04.01 · Status of operational activities
OCMSS04.02 · Status of system maintenance and modification activities
OCMSS04.03 · Status of internal quality control and assurance activities
OCMSS04.04 · Performance monitoring
OCMSS04.05 · Fiscal Agent staffing levels
OCMSS04.06 · A report of all rules engine modifications during the
period
OCMSS04.07 · Baselines and aging data, as well as prior period
performance data
OCMSS05 Provide internal Contract management procedures and
controls, including:
OCMSS05.01 · Management and control procedures to monitor all
Contractor functions
OCMSS05.02 · Management and control procedures to monitor all
subcontractor functions
OCMSS05.03 · Inventory management procedures and controls
OCMSS05.04 · Internal quality control and assurance tools
Appendix N: Operational Requirements 1
State of Mississippi, Division of Medicaid
Request for Proposals #20131025
MS MES and Fiscal Agent Services
OCMSS05.05 · Backlog monitoring, controls, and Contingency Plans
OCMSS05.06 · Project monitoring, controls, and Contingency Plans
OCMSS05.07 · Backup and cross-training plans
OCMSS05.08 · Inventory/database of all provider, member, DOM, and
other contacts (i.e., in person, telephone, written)
· Inventory/database of all other activities (i.e., training
and educational, publications, appeals, fair hearings,
OCMSS05.09 maintenance items and enhancements, SURS cases, EOBs,
complaints, pends, claims resolution, and all other Fiscal
Agent activities)
OCMSS06 Document fully, all Contract management control
procedures in the operations procedures manuals.
Provide DOM with reasonable access to Contractor staff
during normal working hours. Maintain access to staff for
OCMSS07 emergencies by designating and publishing an on-call list
of Contractor staff with contact information for after
business hours.
OCMSS08 Provide coordination of onsite and any off-site work
performed by Fiscal Agent staff.
Monitor quality and work toward continued quality
OCMSS09 improvement in all Contract areas in accordance with the
approved Quality Management Plan (QMP).
Provide, at no additional cost to DOM, an annual Statement
on Auditing Standards No. 70 (SAS 70) audit report by
October 1st of each year. The Contractor must submit
annually a “Report on the Processing of Transactions by
Services Organizations,” as defined in SAS 70. The
OCMSS10 Contractor must respond to each SAS 70 audit with a
proposed Corrective Action Plan (CAP) within 30 calendar
days of the audit, if necessary. The Contractor must
complete implementation of DOM approved CAP within
40 calendar days of approval, unless otherwise specified by
DOM.
Maintain an auditing system and employ
accounting/auditing procedures and practices that conform
to Generally Accepted Accounting Principles (GAAP) and
Generally Accepted Auditing Standards (GAAS). All
OCMSS11 charges applicable to the Contract shall be readily
ascertainable from such records. The Contractor is required
to submit annual financial reports to DOM, within 30
calendar days of receipt of the report from its independent
auditor.
Maintain separate functions and segregate duties of
OCMSS12 personnel to assure adequate financial, security, quality, and
auditing controls consistent with the size and volume of the
Mississippi Medicaid program and GAAP and GAAS.
Appendix N: Operational Requirements 2
State of Mississippi, Division of Medicaid
Request for Proposals #20131025
MS MES and Fiscal Agent Services
Operate a banking unit under separate management from
claims, computer operations, and security units.
Individuals in the same family may not work in any
OCMSS13 combination of the following: Provider Communications
(Call Center), Provider Enrollment, Mailroom, Banking,
Finance, Audit, and Systems Security. Appropriate
separation of duties must be applied to all aspects of
financial management.
Provide all operational facilities, software, and hardware.
OCMSS14 All software licenses and hardware purchased for this
project become the property of DOM.
Provide communication lines. Provide both high-capacity
OCMSS15 primary and backup communication lines and ensure that
available bandwidth is sufficient at all times to meet the
business requirements of DOM.
OCMSS16 Provide system design and programs that meet the
specifications required by this RFP.
Provide DOM documented costs in a cost allocation plan,
OCMSS17 to be approved by CMS, to support the claim for maximum
FFP.
Receive, process, and adjudicate all claims and adjustment
OCMSS18 requests received by the Contractor throughout the Contract
period.
Produce and maintain a detailed work plan and schedule.
The work plan must be in logical sequence of events,
including appropriate review time by DOM and sufficient
OCMSS19 detail for review. Tasks and subtasks, including personnel
hours, beginning and ending dates, and the method of
performance, must be specified for each phase of the
Contract project.
Process and adjudicate correctly all submitted claims for
Medicaid payment and other transactions in accordance
OCMSS20 with federal and State laws, regulations, and policies,
especially pertaining to Medicaid, including the Mississippi
Medicaid State Plan.
Ensure changes made to the MMIS comply with federal
OCMSS21 and State laws, and meet certification and re-certification
requirements.
In the event that an updated version of the Commercial-off-
OCMSS22 the-Shelf (COTS) product(s) becomes available, provide
DOM an impact assessment to determine if updated version
of the product should be implemented.
Subscribe to the Federal Register, the Commerce Clearing
OCMSS23 House, and other appropriate publications to ensure the
Contractor is kept abreast of any changes that may be
scheduled by CMS.
Ensure the MS Medicaid Enterprise contains sufficient
OCMSS24 flexibility to rapidly conform to changes in local, State, or
federal laws, regulations, policies, or priorities.
Appendix N: Operational Requirements 3
State of Mississippi, Division of Medicaid
Request for Proposals #20131025
MS MES and Fiscal Agent Services
Enhance the MS Medicaid Enterprise as directed by CMS
OCMSS25 throughout the Contract period to meet all federal
requirements, at no charge to DOM.
Adhere to national imaging standards, as defined by DOM,
to ensure image quality. All imaged documents must be
OCMSS26 stored for a period specified by DOM. Destruction of the
source document will occur in compliance with State and
Federal Record Retention Laws, 42 CFR 431, 45 CFR Part
74 and 2-6-212, and MCA.
Maintain all data elements, as required by federal
OCMSS27 regulations and any additional data elements as may be
necessary, for DOM to meet all federal data set
requirements for federal reporting and DOM reporting.
Maintain regular communication with DOM and providers,
OCMSS28 in connection with the Contractor's contractual
responsibilities.
Obtain, and keep current, one copy of all current State and
federal laws, regulations, policies, manuals, and the State
Plan pertaining to Medicaid that are applicable to the
OCMSS29 performance of the Contractor's responsibilities under this
Contract. In the event the Contractor has need of an
interpretation of any laws, regulations and/or policies, the
request will be made to DOM.
OCMSS30 Obtain written approval from DOM on all deliverables.
Perform software modifications or developments after the
operational date, as required by DOM. The Contractor may
make a recommendation when, in its opinion, a
modification is needed. The Contractor may not charge for
any computer resources, updates to provider manuals,
OCMSS31 bulletins, newsletters, or any other cost items associated
with implementing improvements or modifications without
DOM prior approval. Charges for computer resources must
be approved in advance by DOM and in accordance with
the agreed-upon change orders and/or amendments, as well
as Contract amendments.
Advise and inform DOM of any procedure(s) that may
OCMSS32 reduce the cost and/or increase the effectiveness of
administering the MS Medicaid program, including claims
processing.
Contact all providers who submit claims electronically and
OCMSS33 make preliminary arrangements for testing of software used
on provider-owned computers for submission of claims.
Submit an Implementation Plan that provides an overview
of the approach that will result in an orderly transition of
OCMSS34 Medicaid Fiscal Agent responsibilities. It is to encompass
all activities necessary to assume the responsibilities as the
Medicaid Fiscal Agent.
Appendix N: Operational Requirements 4
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