Medicaid Administrative Claiming Support Services

The Vendor is required to provide Medicaid administrative claiming support operate and maintain a federally compliant random moment sampling (“RMS”) system, support claim development and calculation activities, provide training and technical assistance to participating agencies, and assist office in preparing quarterly Medicaid administrative claims.
- Random moment sampling administration
• Operate and administer a statistically valid twice-daily stratified RMS process that complies with applicable federal Medicaid requirements and cost allocation principles.
• Maintain a web-based RMS application accessible through standard internet browsers without requiring installation of software on state-owned devices.
• Configure and maintain RMS participant pools, activity codes, schedules, and sampling methodologies necessary to support the mac program.
• Generate and distribute random moments to participating staff.
• Monitor participant response rates and conduct follow-up activities as necessary to maximize compliance.
• Administrative tools that allow office to monitor participation and review sampling results.
• Maintain appropriate system security, user management, and data retention practices.
• Operate the RMS process for all quarters during the contract period.
• Develop and implement enhancements to the RMS or cost allocation system.
- Medicaid administrative claim development and calculation
• Review and document the methodology used to develop quarterly Medicaid administrative claims.
• Collect and compile RMS results and expenditure information provided by office and participating agencies.
• Calculate quarterly Medicaid administrative claims using approved methodologies and cost allocation procedures
• Prepare claim calculation work papers and supporting documentation sufficient for state and federal review.
• Develop claim summaries and reports for office review and approval.
• Submit draft quarterly claim packages to office in accordance with timelines established by office.
• Technical assistance related to claim calculations, supporting documentation, and audit inquiries.
• Support a monthly five percent quality assurance review process conducted by participating agencies and office.
- Reporting and program support
• Develop statewide and agency-specific reports that summarize RMS participation, coding results, response rates, and claiming outcomes.
• Quarterly and ad hoc reports requested by office.
• Generate monthly agency participation reports.
• Identify participation issues, data anomalies, or operational concerns and recommend corrective actions.
• Participate in meetings with office, MQD, participating agencies, and other stakeholders as requested.
• Maintain documentation of processes, procedures, and methodologies used to support mac activities.
• Assist with modifications to the cost allocation plan (“CAP”).
- Training and technical assistance
• Develop training materials, user guides, and reference documents related to RMS participation and mac processes.
• Conduct initial and refresher training sessions for RMS participants, supervisors, and administrators.
• Ongoing technical assistance and support during normal business hours.
• Respond to participant and administrator inquiries regarding system access, RMS completion requirements, and claim-related processes.