Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operations• Configurable Business Process Wizards. The system provides a business process wizard servicethat supports dynamic configuration of business processes using a series of steps from a universe ofpredefined steps. For example, the provider enrollment business process wizard service enables theconfiguration of different steps for different provider types without changing any code.• Workload Manager Services. The system provides a workload queue management framework thatmanages the different workload across process queues. This allows the system to be agile in terms ofmanaging the workload and prioritize tasks between different queues.• Event Driven Notification Framework. The system provides an event-driven notificationframework. The system has a notification service that generates system alerts and or emailnotifications based on system events. These system events are registered in the system and can beeither time based (e.g., provider license expiration in 30 days) or data based (e.g., claims paid dollaramount exceeded threshold of $100 million in a single day).• Data Auditing and Tracking Service. The system provides an auditing service that performs thetask of managing all changes performed via user action and back-end services. This service ensuresthat there is complete tracking in the system for changes and action performed by a user.• Security Services. The system provides a series of services such as authentication and authorizationto enable control in terms of access into the system and sensitive health data. The security service alsoenables the ability for a seamless log-on across different components by passing the authenticationcredentials in a security object.Proposed Solution Alignment with RFP RequirementsTeam Noridian’s proposed new MMIS components, outlined earlier in this section, provide a very robust,out-of-the-box functionality to meet the requirements, as outlined in the RFP. Figure 9-7 shows that 80percent of the requirements are already included in the new MMIS solution or require only configurationchanges. This not only reduces the risk of implementation for the Department, but also shows thecompleteness of the new MMIS in terms of its capabilities.No. Requirement Classification % of Total Requirements1 Proposed solution meets the requirements as stated 100.00%2 Proposed solution has existing capability 80.37%3 Proposed solution (eCAMS) or COTS require software modification is required to meet proposed solution 19.63%Figure 9-7. Requirement Classification Table. Team Noridian’s proposed system minimizesimplementation risks since the majority of the requirements are included in the system or require onlyconfiguration changes.Proposed Solution Features and BenefitsTeam Noridian's proposed eCAMS solution has realized significant Medicaid operations benefits in thestates of Washington and Michigan. Team Noridian is proud to present the features that eCAMS brings toIowa Medicaid program listed in Figure 9-8.FeatureProduct CentricApproach to eCAMSProactive Fraud and AbuseBenefitTeam Noridian has approached the implementation of the MMIS solution with a product-centric approach, instead of a typicalproject-centric approach of proposed solution. Team Noridian centrally maintains the core of the solution, allowing ongoinginnovations in the solution base to be made available to all states in a more cost-effective manner. The product approachpromotes natural incorporation of best business practices from different states as they are incorporated in the base solution.The eCAMS system provides a powerful framework capable of enforcing billing patterns at the time of claims data capture toprevent fraud in the first place. The system leverages Team Noridian’s RuleIT rules engine to configure billing patterns that areenforced by the eCAMS Health Care Engine (HCE). Team Noridian believes that the flexibility of the system to configureadditional billing patterns provides a powerful framework to prevent fraud at the time of entry of information in the system.9 | 14