Contractor MIS. The Contractor shall maintain a Management Information System (MIS) that will provide support for all aspects of a managed care operation to include the following subsystems: Enrollee, Third Party Liability, provider, reference, Encounter/Claims processing, financial, utilization data/ Quality Improvement and Surveillance Utilization Review Subsystem. The Contractor will also be required to demonstrate sufficient analysis and interface capacities. The Contractor’s MIS shall ensure medical information will be kept confidential at all times including but not limited to when data is moving and at rest, through security protocol, especially as that information relates to personal identifiers and sensitive services. The Contractor shall comply with 42 C.F.R. 438.242. The Contractor shall provide such information in accordance with the format and file specifications for all data elements as specified in Appendix G “Management Information Systems Requirements” hereto, and as may be amended from time to time. The Contractor shall transmit all data directly to the Department in accordance with 42 C.F.R. 438. If the Contractor utilizes Subcontractors for services, all data from the Subcontractors shall be provided to the Contractor and the Contractor shall transmit the Subcontractors’ data to the Department in a format specified by the Department in accordance with 42 C.F.R. 438. The Contractor will execute a Business Associate Agreement (BAA) in Appendix H “Business Associates Agreement” with the Department, pursuant to Sections 261 through 264 of the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, known as “the Administrative Simplification provisions,” that directs the federal Department of Health and Human Services to develop standards to protect the security, confidentiality and integrity of health information. The execution of the BAA is required prior to data exchanges being implemented. The Contractor shall meet all system requirements, including but not limited to required testing, as directed by the Department. Upon request by the Department, the Contractor shall participate in Joint Application Development sessions for system or policy changes. At least ten (10) Days prior to implementation, the Contractor shall notify the Department of any significant changes to the system that may impact the integrity of the data, including such changes as new Claims processing software, new Claims processing vendors and significant changes in personnel.
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