Interfaces Maintained. The Contractor shall maintain the following systems: A. An effective interface between the MMIS/MEMS and the Contractor’s system(s) for pharmacy claims processing; B. A dedicated communication line connecting the MMIS/MEMS to the Contractor’s processing site. The cost of this communication line is to be solely at the expense of the Contractor. This dedicated communication line shall meet specifications of the Department; and C. The ability to accept transaction data that changes baseline MMIS/MEMS files on a daily basis unless the Department approves a more/less frequent schedule. (1) The file transfer schedule shall, at a minimum, result in the daily update of the POS system with the most current information from the MMIS/MEMS. This may include, but not be limited to, member eligibility, PA information, and provider file(s) or reference information; (2) The interface between Contractor’s system(s) and the MMIS/MEMS system shall be compatible. This assumes no significant changes to the MMIS/MEMS file structures will be required; (3) The Contractor should adhere to all Change Management requirements prior to implementing any changes to existing or new interfaces from the MMIS/MEMS; and (4) The Contractor should update all MMIS/MEMS data without manual intervention, unless approval from the Department is provided. NOTE: Federal regulations require the Department to maintain appropriate controls over POS eligibility contractors who perform both switching services and billing services. Switch and billing agent functions, if provided by the same company, shall be maintained as separate and distinct operations. If the contractor serving as the POS contractor also provides services as the providers’ agent, an organizational firewall shall be in place to separate these functions.
Appears in 2 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract
Interfaces Maintained. The Contractor shall maintain the following systems:
A. An effective interface between the MMIS/MEMS and the Contractor’s system(s) for pharmacy claims processing;
B. A dedicated communication line connecting the MMIS/MEMS to the Contractor’s processing site. The cost of this communication line is to be solely at the expense of the Contractor. This dedicated communication line shall meet specifications of the Department; and
C. The ability to accept transaction data that changes baseline MMIS/MEMS files on a daily basis unless the Department approves a more/less frequent schedule.
(1) The file transfer schedule shall, at a minimum, result in the daily update of the POS system with the most current information from the MMIS/MEMS. This may include, but not be limited to, member eligibility, PA information, and provider file(s) or reference information;
(2) The interface between Contractor’s system(s) and the MMIS/MEMS system shall be compatible. This assumes no significant changes to the MMIS/MEMS file structures will be required;
(3) The Contractor should adhere to all Change Management requirements prior to implementing any changes to existing or new interfaces from the MMIS/MEMS; and
(4) The Contractor should update all MMIS/MEMS data without manual intervention, unless approval from the Department is provided. NOTE: Federal regulations require the Department to maintain appropriate controls over POS eligibility contractors who perform both switching services and billing services. Switch and billing agent functions, if provided by the same company, shall be maintained as separate and distinct operations. If the contractor serving as the POS contractor also provides services as the providers’ agent, an organizational firewall shall be in place to separate these functions.
Appears in 2 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract
