Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsTeam Noridian team members will also be required to sign a HIPAA business associate agreement forhandling data containing personal health information (PHI).7.3.3.5 Quality and Performance Improvement ProceduresRFP Section 5.3.3, Requirement k, n, and oTeam Noridian fosters a culture of continuousperformance improvement in all of its lines ofbusiness, and will continue this philosophy witheCAMS and the Core MMIS operations contract.A few examples of these efforts include:• We received kudos from the IME Medical Services contractor recently when we built a newworkflow that resulted in "most advanced project that we have created and the most advancedworkflow we have in Medical Services".• Noridian continually assesses and designs changes and updates to the IME OnBase workflow systemwhich results in increased efficiencies for all IME contractors.• At the IME, we developed a new report to identify potential claim overpayments before the paymentcycle was run.• Noridian implemented an automated tool and process at the IME that improved quality and reducedthe manual efforts in working claims.• We implemented a cross-training program within the Core MMIS operations to reduce vulnerabilitiesand improve efficiencies.• We created performance metrics within each of the Core MMIS operations teams to establishproductivity levels and utilization.• In our Medicare claims processing business, we introduced automation to decrease the Jurisdiction 3(J3) Part A/B Medicare Administrative Contractor (A/B MAC) institutional claims suspense rates toless than one percent.• We were also able to decrease J3 A/B MAC professional claims suspense rates from 20 percent tofour percent using automation.• We reduced improper claim payments by $3 million by actively participating in Administrative LawJudge hearings.• Implementation of the automated workflow and image retrieval capabilities in our Medicare businessallowed us to combine business rules and actions throughout the functional areas, saving theMedicare Program $3.2 million per year while maintaining accuracy and increasing efficiency andcustomer service.• CNSI has implemented further automation in eCAMS to catch many overpayments before the checkis issued, saving the time and effort needed for pay-and-chase activities.We will continue to initiate and maintain aggressive efforts designed to proactively identify ways toimprove the performance of critical work functions. Managers, supervisors, and quality analysts willconduct regular workflow analysis of processes within each of our areas. As process improvementopportunities are identified, or changes to workflow are needed to enhance or improve performance,the quality analyst will work with the functional area supervisor or manager to assure suggested changesare documented.We will work with the Department to apply a process improvement review procedure at regularlyscheduled points during the operations phase of the project. The frequency of these process improvementreviews will be determined with input from the Department. To facilitate these reviews, we will:• Use a structured, documented methodology to conduct these reviews• Ensure results and recommendations from the reviews are documented and distributed to theappropriate parties7 | 29