Maintain the benefit package associated with each benefit 47. BEB47 plan, including any rules that apply. Maintain member data, including all designated original 48. source data, and all other data that is necessary to manage all of the business functions of KY Medicaid. Add new groups of eligible members, as distinguished by 49. BEB49 program code or functionality, when directed by CHFS, or its designee. Support the administration of a variety of benefit packages 50. BEB50 and claims processing and program administration requirements. Support the administration of a variety of service delivery models, including, but not limited to, full-risk capitation, 51. BEB51 primary care capitation, physician case management, MCO agreements, vendor contracting arrangements, and utilization controlled FFS arrangements. Receive requests from DMS for benefit package updates; 52. validate, test, receive CHFS approval, and then implement according to CHFS specifications. Make available to CHFS, or its designee, online inquiry and 53. BEB53 update capability for access to the EPSDT data. Identify and report abnormalities found during screenings and 54. BEB54 referred for treatment, from data submitted on claim forms. Identify and report (from paid, denied and pended 55. service and encounter claims) members receiving treatment under the EPSDT program.
47. BEB47 Maintain the benefit package associated with each benefit plan, including any rules that apply. 48. Maintain member data, including all designated original source data, and all other data that is necessary to manage all of the business functions of KY Medicaid. 49. BEB49 Add new groups of eligible members, as distinguished by program code or functionality, when directed by CHFS, or its designee. 50. BEB50 Support the administration of a variety of benefit packages and claims processing and program administration requirements. 51. BEB51 Support the administration of a variety of service delivery models, including, but not limited to, full-risk capitation, primary care capitation, physician case management, MCO agreements, vendor contracting arrangements, and utilization controlled FFS arrangements. 52. Receive requests from DMS for benefit package updates; validate, test, receive CHFS approval, and then implement according to CHFS specifications. 53. BEB53 Make available to CHFS, or its designee, online inquiry and update capability for access to the EPSDT data. 54. BEB54 Identify and report abnormalities found during screenings and referred for treatment, from data submitted on claim forms. 55. Identify and report (from paid, denied and pended and encounter claims) members receiving treatment under the EPSDT program. service
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx