J.01.C Fee-for-Service Shared System Base Functions 03302022.docx

RFP # 75FCMC22R0002

Attachment J.01.C – Fee-for-Service Shared System Base Functions

75FCMC22R0002 Fee-for-Service Shared System Base Functions Attachment J.01.C Appendix C to SOW, dated 03/28/2022 MAC Shared System Base and Non-Base Functions

Data Center security ID and password that controls access into the data center, access into the CICS regions, access to CICS transactions, and read/write access to files.

Data Center security Machine-ID and non-expiring password that controls access into the data center for functions such as Interactive Voice Response (IVR), Next Generation Desktop (NGD), Sequential Terminals and FEPI.

Tele-communications

Works with CMS-approved contractors as necessary to establish batch and interactive connectivity between the data centers.

The VDC receives files transmitted from CMS approved contractors.

CEDI performs claims receipt, control and balancing for inbound claims from providers and the delivery to the VDC for processing.

The VDC creates and maintains the jobs necessary to transmit CMS approved files from the VDC to any other location.

Direct Data Entry (DDE) application for provider on-line inquiry of claims information (VPIQ/PINQ).

Automated Development System (ADS), including a base letter file selected from an existing user.

Creation and execution of the jobs to transmit the base print output to the contractor local data center.

CMN Maintenance (VDME)

On-line claims entry and work scheduler (VMON/APEX)

Express Adjustments

Weekly QA sampling

SuperOp

Automated pricing of claims

MSP automated payment calculation

Receipt and installation of ECRS software.

· Workload and Performance reports;

· Appeals;

· Medical Review Workload;

· PIMR;

· MSP Savings VMS provides reports to track processed claims.

Creation and execution of the jobs to transmit the various required reports to CMS.

Telecommunications mechanism between the VDC and PECOS.

Retrieval of the Daily Export Extract file from PECOS.

Creation and execution of bank-specific interfaces for Issues file (optional, with CMS approval).

Creation and execution of the jobs to transmit the issues file to the bank or contractor data center.

Receipt of the Clears file from the bank (optional).

Creation and execution of bank-specific interfaces for Clears file (optional, with CMS approval).

Mailroom-ready output document files, suitable for printing on IBM equipment, that have:

· Produce Basic AFP mixed mode print file or image file that could be used to produce other formats;

· Separate checks, MSNs, and remittance with AFP mixed mode formatted print streams;

· English language printed output for all documents

· Spanish language and/or alternate formats for the beneficiary Medicare Summary Notice (MSN);

· Base Presort processing.

Creation and execution of the jobs to transmit the base print or image file output to the contractor’s print site (if routing is not done via the JCL).

Creation and execution of the jobs to transmit the ACH records to the bank or the contractor data center.

Creation of electronic claim status response transactions on one of the CMS-mandated flat file formats.

Creation and execution of the jobs to transmit the data to the contractor data center.

Creation of crossover data for the BCRC in the mandated flat file format.

Creation and execution of the jobs to transmit the crossover data to the BCRC.