Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsWe document the findings from process reviews and conduct meetings with the affected area’s teammembers and management. When necessary, the affected supervisor or manager, with other assistance asneeded, develops a corrective action plan (CAP) to correct the deficiency. When this occurs, we willprovide the Department with the CAP within 10 days of the discovered problem for their review andapproval. We will discuss and develop a timeline for the plan to be implemented. If it results in systemchanges, we will execute the CAP using ourestablished SDLC methodology and changemanagement procedures. The plan could alsoinvolve other changes or actions such as newtraining initiatives, updates to operationalprocedures, increased employee monitoring, ordisciplinary action depending on thecircumstances. For any of these CAPs, we trackand provide updates through to completion andwill immediately notify the Department of anyproblems with its implementation.7.3.1.6 Internal Operational AuditsA key component of our internal QA program isthe performance of internal operational audits.Noridian, the prime contractor, has a designatedteam within our corporate organizationresponsible for conducting independent auditsof all operational areas on a regular basis. Thisoperations review team, comprised ofknowledgeable internal auditors, conducts theseoperational reviews. The audits provide anoutside-of-the-operational-area verification thatoperations are meeting contract performancerequirements, including requirements associatedwith accuracy, timeliness, and quality. Inaddition, the reviews provide assurance thatproper internal controls are in place andreporting is accurate. The operations reviewteam has conducted annual audits on the IMECore contractor business functions for the pastsix years and will continue this practice into thenear future.The operations review team follows adocumented standard audit process of planning,scheduling, conducting, reporting results, andmaintaining records of internal audits. Internalauditors are trained on the audit standards andcontract performance requirements. The auditstandards are available to the auditors online forreference. The 150-page manual describes theinternal audit process the internal auditors followand contains the audit work paper and audit filestandards along with examples. The manualoutline is shown in Figure 7-3.Figure 7-3. Audit Outline. The operations reviewteam follows a documented standard auditprocess of planning, scheduling, conducting,reporting results, and maintaining records ofinternal audits.7 | 23