Provide decision-making support, with an emphasis on and non-structured queries and reporting. Provide 651. DWB74 the ability to easily detect, analyze, and reports/information patterns in the Kentucky Medicaid Program expenditures. Ensure that the Data Warehouse is to run 24/7, with exception 652. DWB75 of scheduled maintenance downtimes. Support all DSS/DW functions, files, and data elements 653. DWB76 necessary to meet the requirements of this RFP, CMS Certification Standards, and the State Medicaid Manual. Recommend all additional fraud and abuse methods, 654. DWB77 algorithms, actions, activities, theories, tools, and techniques of which the MEMS Vendor becomes aware. Design and implement activities to proficiently and proactively 655. detect potential fraud and abuse by all providers and members. Design and implement activities to proficiently and proactively detect inappropriate billings and over payments, and 656. violations of provider instructions conveyed by applicable Medicaid handbooks and bulletins. Design and implement activities to proficiently and proactively 657. DWB80 detect significant percentage increases or decreases in a provider’s claims. Perform detection and normative benchmarking of use, cost, 658. DWB81 and treatment patterns using clinically and analytically defensible provider grouping and profiling methodologies. Perform detection and normative benchmarking of use, cost, 659. DWB82 and treatment patterns using review criteria and standards.
651. DWB74 Provide decision-making support, with an emphasis on and non-structured queries and reporting. Provide the ability to easily detect, analyze, and reports/information patterns in the Kentucky Medicaid Program expenditures. 652. DWB75 Ensure that the Data Warehouse is to run 24/7, with exception of scheduled maintenance downtimes. 653. DWB76 Support all DSS/DW functions, files, and data elements necessary to meet the requirements of this RFP, CMS Certification Standards, and the State Medicaid Manual. 654. DWB77 Recommend all additional fraud and abuse methods, algorithms, actions, activities, theories, tools, and techniques of which the MEMS Vendor becomes aware. 655. Design and implement activities to proficiently and proactively detect potential fraud and abuse by all providers and members. 656. Design and implement activities to proficiently and proactively detect inappropriate billings and over payments, and violations of provider instructions conveyed by applicable Medicaid handbooks and bulletins. 657. DWB80 Design and implement activities to proficiently and proactively detect significant percentage increases or decreases in a provider’s claims. 658. DWB81 Perform detection and normative benchmarking of use, cost, and treatment patterns using clinically and analytically defensible provider grouping and profiling methodologies. 659. DWB82 Perform detection and normative benchmarking of use, cost, and treatment patterns using review criteria and standards.
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx