PL 001.docx
DOCX document 29 KB Posted
- Attached to
- Pharmacy Benefit Services (PBS)
- Solicitation number
- 5400029905
- Issued by
- Richland County, South Carolina
About this file
This document is an acronym reference guide for the Medicaid Enterprise System (MES) contract opportunity involving the South Carolina Department of Health and Human Services (SCDHHS) and the South Carolina Department of Information Security (SCDIS). The guide defines over 50 technical, regulatory, and operational acronyms essential to understanding the MES initiative, which represents the collection of systems, modules, and business functions comprising SCDHHS' Medicaid program. Key acronyms include MES Core, which serves as the enterprise information hub for integrating different components; MMIS, the automated claims processing system; and various compliance frameworks such as ARC-AMPE for privacy and security standards, FedRAMP for cloud service compliance, and HIPAA for patient health information protection. Additional important terms include ATO (Authority to Operate), which contractors must acquire from SCDHHS prior to processing government data; CEF (Conditions for Enhanced Funding) representing CMS-defined expectations for state certification; and KPI (Key Performance Indicators) for measuring performance against CMS requirements.
The document also outlines critical technical standards and protocols necessary for system implementation and interoperability, including FHIR and HL7 standards for health information exchange, REST and SFTP for secure data transfer, and API architecture for module communication. Compliance and security considerations are emphasized through references to NIST standards, SSP (System Security Plan) deliverables, SLA requirements, and testing phases including SIT, UAT, and various performance objectives such as RPO and RTO for disaster recovery planning. The acronym guide serves as foundational reference material for all contract participants, bidders, and stakeholders involved in the development, implementation, and maintenance of SCDHHS' Medicaid enterprise systems, ensuring standardized terminology and understanding across all parties throughout the contract term.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTM 021.pdf | ||
| ATTM 022.pdf | ||
| ATTM 024(a).docx | DOCX document | |
| ATTM 016.pdf | ||
| ATTM 014.pdf | ||
| ATTM 005.docx | DOCX document | |
| ATTM 006.docx | DOCX document | |
| ATTM 008.xlsx | XLSX spreadsheet | |
| PL 003.pdf | ||
| ATTM 009.xlsx | XLSX spreadsheet | |
| ATTM 017.pdf | ||
| ATTM 024(b).xlsx | XLSX spreadsheet | |
| ATTM 018.pdf | ||
| PL 002.pdf | ||
| ATTM 003.docx | DOCX document | |
| ATTM 013.xlsx | XLSX spreadsheet | |
| ATTM 019.pdf | ||
| ATTM 011.pdf | ||
| ATTM 015.pdf | ||
| ATTM 023.xlsx | XLSX spreadsheet | |
| ATTM 010.docx | DOCX document | |
| ATTM 026.docx | DOCX document | |
| ATTM 020.pdf | ||
| ATTM 007.docx | DOCX document | |
| Solicitation 5400029905.docx | DOCX document | |
| ATTM 025.docx | DOCX document | |
| ATTM 012.xlsx | XLSX spreadsheet | |
| ATTM 004.docx | DOCX document | |
| ATTM 001.docx | DOCX document | |
| ATTM 002.docx | DOCX document |
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Text version
| PL 001 | MES Acronyms |
| Acronym | |
| Definition | |
| Details |
| API |
| Application Programming Interface |
| Interface allowing MES Modules to communicate and transfer data. |
| ARC-AMPE |
| Acceptable Risk Controls for ACA, Medicaid, and Partner Entities |
| Set of privacy and security standards for Affordable Care Act administering entities and their subcontractors. |
| ATO |
| Authority to Operate |
| Contractor must acquire ATO from SCDHHS/SCDDSN prior to processing of government data, with ATO maintenance and review intervals determinant upon the term of Contract award. |
| CDML |
| Contract Deliverables Management List |
| Outlines the minimum expected requirements for SCDHHS third-party contracts, including deliverables and their respective standards. |
| CEF |
| Conditions for Enhanced Funding |
| CMS-defined expectations State Medicaid Agencies are required to meet in order to receive CMS Certification of MES Modules. |
| CIO |
| Chief Information Officer |
| SCDHHS CIO and Executive Steering Committee member. |
| CMS |
| Centers for Medicare & Medicaid Services |
| Federal governing body for State Medicaid programs. |
| DASH |
| Delivery of Automated Systems for Healthcare |
| SCDHHS’ internal Project Management Office. |
| DDI |
| Design, Development, Implementation |
| Initial solution implementation phase, concurrent with the Implementation Phase of the EVV Contractor’s contract. |
| DUR |
| Drug Utilization Review |
| An ongoing process for monitoring and improving drug use and safety. |
| EFT |
| Electronic Funds Transfer |
| A method used to move funds from one account to another. |
| ET |
| Eastern Time |
| Eastern Time Zone. |
| FedRAMP |
| Federal Risk and Authorization Management |
| United States federal government compliance program that promotes the adoption of secure cloud services in government agencies. |
| FERPA |
| Family Educational Rights and Privacy Act |
| United States federal law governing access to educational information and records by public entities such as potential employers, publicly funded educational institutions, and foreign governments. |
| FFS |
| Fee for Service |
| Services model in which Medicaid pays doctors and healthcare professionals directly for each service they provide |
| FHIR |
| Fast Healthcare Interoperability Resources |
| Health Level Seven International® (HL7®) standard for exchanging health care information electronically. |
| HIPAA |
| Health Insurance Portability and Accountability Act |
| United States federal law requiring the creation of national standards to protect sensitive patient health information from being disclosed without patient knowledge or consent. |
| KPI |
| Key Performance Indicator |
| A CMS-defined, quantifiable measures of performance over time, required for CMS Certification. |
| Lock-In |
| Medicaid Lock-In Program |
| A health and safety program that requires enrollees to obtain their care and/or services from a designated provider or providers. |
| MCO |
| Managed Care Organization |
| Entities that serve Beneficiaries on a risk basis through a network of contracted providers. |
| MES |
| Medicaid Enterprise System |
| The collection of systems, modules, and business functions that comprise SCDHHS’ Medicaid program. |
| MES Core |
| MES (Medicaid Enterprise System) Core |
| MES Core serves as the SCDHHS enterprise information hub for providing a consistent way of integrating with the different components in the Enterprise Architecture |
| MMIS |
| Medicaid Management Information System |
| Automated Medicaid claims processing and information retrieval system. |
| NCPDP |
| National Council for Prescription Drug Programs |
| An ANSI-accredited, non-profit organization that develops and maintains standards for the exchange of healthcare information. |
| NDC |
| National Drug Code |
| A numerical code maintained by the FDA that includes the manufacturer labeler code, product code, and package code. |
| NIST |
| National Institute of Standards and Technology |
| United States Department of Commerce Agency promoting industrial competitiveness and innovation in government agencies. |
| OCS |
| Office of Cybersecurity |
| SCDHHS’ internal information assurance office |
| Portable Document Format |
| Document format. |
| PMO |
| Project Management Office |
| The DASH Team serves as the PMO for the SCDHHS CIO. |
| POA&Ms |
| Plans of Action & Milestones |
| A document that identifies and details tasks required to accomplish a plan and any milestones. |
| P&T |
| Pharmacy and Therapeutic Committee |
| A committee of physicians and pharmacists responsible for reviewing clinical appropriateness of practices and policies for formulary management activities. |
| Rx BIN |
| Pharmacy Bank Identification Number |
| A 6-digit code that identifies a drug plan provider |
| RX PCN |
| Pharmacy Processor Control Number |
| Used to determine which specific pharmacy benefit manager (PBM) should be used for a claim |
| REST |
| Representational State Transfer |
| Software architecture that ensures interoperability between different computer systems on the internet by providing communication standards. |
| RPO |
| Recovery Point Objective |
| Maximum acceptable data loss after recovery from system failure, disaster, or data loss incident. |
| RTO |
| Recovery Time Objective |
| Maximum acceptable amount of elapsed time |
| SCDHHS |
| South Carolina Department of Health and Human Services |
| South Caroline state agency responsible for the administration of South Carolina’s Medicaid program. |
| SCDIS |
| South Carolina Division of Information Security |
| Part of the South Carolina Department of Administration’s Office of Technology and Information Services that is responsible for a variety of statewide policies, standards, programs and services relating to cyber security and information systems. |
| SFTP |
| Secure File Transfer Protocol |
| A network protocol for securely accessing, transferring and managing large files and sensitive data. |
| SIT |
| System Integration Testing |
| Software testing phase that verifies all system components are integrated and work together as expected. |
| SLA |
| Service Level Agreement |
| A set of expectations between service provider and customer defining the standards to be followed throughout the established contract period. |
| SOA |
| Service Oriented Architecture |
| A method of software development that uses software components called services to create business applications. |
| SME |
| Subject Matter Expert |
| SCDHHS employees and contractors providing subject matter expertise regarding requirements, design and development, and testing. |
| SSP |
| System Security Plan |
| Required Contractor deliverable via CDML. |
| TPL |
| Third Party Liability |
| Third Party Liability MMIS subsystem. System that manages the legal obligation of third parties to pay all or part of the expenditures for medical assistance furnished under a State plan. |
| UAT |
| User Acceptance Testing |
| The phase of software testing in which the software is tested using real word scenarios by the end users or business representative. |
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