Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsJAD sessions during requirements validation, with the exception that these sessions focus on the detailedphysical design of the system and how that design meets the approved requirements. To prepare for theJAD sessions, we will:• Review the RSDs• Update the requirements database• Update the installation of our eCAMS platform with the latest version• Present the DSD approach to Department staff• Coordinate with Department team counterparts to schedule system demonstrations and JAD sessionsTeam Noridian will continue to use a process that integrates real time use of the requirements databaseand our eCAMS platform with the actual DSD sessions. Together, Team Noridian and Department willreview architectural diagrams, system flow diagrams, and physical data models. The transfer solution willbe used to visually convey existing transfer solution functions. This approach allows Team Noridian andthe Department to reach a consensus on the system configuration and rules engine population,implementation of COTS products and design, development of missing functionality and interfacedevelopment and data conversion. The design activities are tightly coupled with the data mapping anddesign activities for data conversion. In parallel with the design, the conversion team will be conductingdata mapping from the source files to the new MMIS database tables. Members from the business areateams will be asked, as required, to attend the conversion mapping sessions, and specific conversion teammembers will be asked to attend the DSD JAD session to ensure the design and business rules betweenthe business area functionality and data conversion are in sync.As each JAD sessions are completed for each business area, the dedicated team for that business area willbegin the iterative development of the DSD document for that specific business area. Separate DSDdocuments will be developed and delivered for the business process area, each of which includes theirvalidated requirements.The RTM will be updated for each business area to reflect traceability of the requirements to the detailedsystem design components. This will be the formal delivery of the RTM for the design task and will beused as a starting point for the development and testing activities.Documentation of all RulesRFP Section 6.3.1.2, Requirement r.1There are various kinds of business rules Team Noridian will document and maintain for the new MMIS.These rules are as follows:• HIPAA Validation Rules. These rules are executed when data is loaded in MMIS system. Typicallythese are additional validation or derivation rules. Team Noridian maintains these rules in a series ofspreadsheets that accompany the DSD for that business area. These HIPAA validation rules includedetails description of edits, edit type, X12 element on which this rule is executed, and derivationlogic.• Adjudication Edits. Contains all edits/audits for adjudicating various claim types.• Adjudication Exhibits. Contains benefit plan assignment, fund code assignment, aid categoryassignment and various pricing rules.• Screen Validation and Business Rules. Team Noridian maintains screen validation and businessrules for eCAMS web functionality the DSD. These are the system rules define a behavior of asystem in a particular condition.Figures 8-39 and 8-40 provide two examples of rules documentation that is included as a part of the DSDfrom prior MMIS implementations.8 | 68