Section 14 – Management Information System Sample Clauses

Section 14 – Management Information System. (MIS) Requirements 1. describe the Management Information System (MIS) the Respondent will implement, including how the MIS will comply with Health Insurance Portability and Accountability Act of 1996 (HIPAA). The response must address the requirements of Section 8.1.18. At a minimum, the description should address: a. hardware and system architecture specifications; b. data and process flows for all key business processes in Section 8.1.18.3; and c. attest to the availability of the data elements required to produce required management reports; 2. if claims processing and payment functions are outsourced, provide the above information for the Material Subcontractor; 3. describe how the Respondent would ensure accuracy, timeliness, and completeness of Encounter Data submissions for each of the MCO Programs bid; 4. describe the Respondent’s ability and experience in performing coordination of benefits and Third Party Liability/Third Party Recovery (TPL/TPR); 5. describe the Respondent’s ability and experience in allowing providers to submit claims electronically and its ability and experience in processing electronic claims payments to providers: a. if currently processing claims electronically, generally describe the type and volume of provider claims received electronically in the previous year versus paper claims for each claim type; b. if currently making claims payments to providers electronically, generally describe the type and volume of provider claims payment processed electronically; c. does the MCO provide a no-cost alternative for providers to allow billing without the use of a clearinghouse? If so please describe; and d. does the MCO include attendant care payments as part of the regular claims payment process (for STAR+PLUS only)? If so please describe; 6. describe the Respondent’s experience and capability to comply with the Internet website requirements of Section 8.1.5.5, and briefly describe any additional website capabilities that the Respondent proposes to offer to Members or Providers; 7. provide acknowledgment and verification that the Respondent’s proposed systems are 5010 compliant by submitting a copy of the 5010 compliancy plan, and proposed timeline for meeting the deadlines for being 5010 compliant; and 8. describe the Respondent’s capability to pay providers via direct deposit and its experience in doing so, including the percentage, number, and types of providers paid via direct deposit in the most recent 12 month period for wh...