Specifications include, but are not limited to: 1. The Contractor shall be responsible for determining beneficiary eligibility for the ARHIPP program based on DHS-provided criteria in accordance with the promulgated rules of the Arkansas Health Insurance Premium policy (Attachment N). The Contractor must develop an online and paper application for Beneficiary use in applying for the program. The application must collect only information necessary for determining Beneficiary eligibility based on DHS program criteria and must be approved by DHS. DHS will provide access to MMIS and to files DHS determines necessary for the fulfillment of contractual requirements. The Contractor must provide the Average Annual Medical Costs (AAMC) methodology used to determine beneficiaries’ cost-effectiveness for the ARHIPP program. 2. The Contractor shall verify ARHIPP applicant’s insurance policy number, group number, RX group number, Processor Control Number (PCN), Bank Identification Number (BIN), and effective date of coverage and shall record the history of this plan information within the ARHIPP system. The Contractor shall develop a daily electronic file to transfer this policy information to the MMIS with the Medicaid enrollee’s ARHIPP eligibility data. 3. The Contractor shall make an ARHIPP eligibility decision and mail written notice of decision to the Policyholder for all submitted ARHIPP applications within thirty (30) calendar days of receipt. 4. The Contractor shall re-determine ARHIPP eligibility for each active case prior to the end of the employer’s open enrollment periods. 5. The Contractor’s ARHIPP system shall have the ability to accept a daily electronic Medicaid eligibility and TPL file from the MMIS. The Contractor shall utilize the eligibility data contained within the files to update existing ARHIPP cases and to establish new ARHIPP cases. Contractor shall develop a workflow process to alert ARHIPP operational staff of changes to ARHIPP cases. Records shall be maintained for a minimum of ten (10) years after the termination of the contract. 6. The Contractor shall develop and send notices in accordance with the DHS policies and procedures. The Contractor shall not utilize any notice that has not been approved by DHS. At the direction of DHS, the Contractor notices shall be sent to the Medicaid Beneficiary’s record in the MMIS accompanied by a case activity log (CAL) entry to MMIS in a daily electronic file. Contractor shall monitor the timeliness of the notice delivery process and report monthly to DHS a list of untimely notices sent. 7. The Contractor shall develop a check write file to include paper check and direct deposit information in conjunction with the DHS fiscal protocols and formatting requirements sent to MMIS in a weekly electronic file. The Contractor shall reconcile ARHIPP cases by processing the monthly clear and void files provided by the MMIS fiscal section and shall notify DHS if the files are not received from the MMIS fiscal section by the 15th day of each month...
