Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.1.1-2. Overview of Proposed Member Management Business Process Area. TeamNoridian’s MITA-aligned eCAMS member business process areas provide IME a reliable andinteroperable solution.eCAMS Member Data StructureThe eCAMS online application is the core system that interacts with the eCAMS Oracle On-LineTransaction Processing (OLTP) member data repository. The member data repository holds acomprehensive scalable data structure to house the member information. Authorized users can inquirethrough eCAMS online screens about member information stored in the OLTP database, can initiate andtrack member correspondence and EPSDT schedules, and can screen and track benefit plan9.1.1.1 | 12
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operationsadministration. eCAMS includes functionalities such as mass transfer of members from one plan toanother, tracking and managing TPL information, initiating and tracking preventive care correspondence,administrating eligibility updates, maintaining plan restrictions, and tracking service utilization.The eCAMS OLTP data structure is based on relational database management and is optimallynormalized to facilitate the scalability and integrity of the stored data. The member data structure isdesigned to hold members tied to multiple data sources and programs. eCAMS security is granular andcan be administered to facilitate user access to a particular member data source, to a member program, orat the member plan level. The member data structure contains built-in data audit services to enforce PHIaccess audits, and it maintains histories of all available member attributes. Member history information ismaintained through data columns such as “start date” and “end date.” The benefit plan structures andeligibility structures are flexible enough to hold unlimited historical data and multiple eligibility criteriafor an individual.Comprehensive Letter and Correspondence SupporteCAMS also includes an integrated letter and correspondence generation feature, which is supportedthrough the correspondence management system based on the DOC1 tool from Pitney Bowes. Theseprocesses can be run on demand as well as through a batch letter generation process. A copy of thegenerated letter also gets stored in the document management system for future access. eCAMS is alsoseamlessly integrated with the document management system to retrieve documents and correspondencetied to a member.EXACT Interface ServiceEXACT acts as the enterprise interface service bus and will support the upload of eligibility batch feedsfrom Title XIX Eligibility, MMIS, ISIS and other sources into the member data repository. eCAMS hasthe flexibility to receive real-time eligibility data through Web services. The interface service alsofacilitates error escalation and notification models to report on transaction failures related to eligibilityfeed updates. The eCAMS online interface definition functionality facilitates an administrator’s ability todefine new interface definitions, including transport details such as input and output file names,dependant interfaces, error threshold information, error notification contact information, and errorescalation notification information.MITA Business AlignmentThe guiding principle for the MITA Business Architecture is “a business-driven enterprisetransformation” and Team Noridian’s eCAMS is geared towards this paradigm by blending the righttechnical components to aid the business transformation. Team Noridian has developed the business layerfor eCAMS, building in many of the core functionality of the different process areas of an MMIS. TeamNoridian believes eCAMS is uniquely best positioned to align itself with the MITA framework, based onthe goals and objectives of the Department.The MITA Business alignments for the various processes involved in the member management businessarea are provided in the Table below in Figure 9.1.1.1-3.# Group Processes eCAMS Alignment eCAMS MITA Maturity Level (ML) Compliance/Notes1 Member Management Determine EligibilityNot Applicable(N/A)Business process area that is covered in Statewide eligibility systems2 Member Management Enroll Member Yes3 Member Management Disenroll Member YesPart of managed care functionality and refers to enrolling within managedcare programs; system is designed for ML-3. Medicaid eligibility isdetermined by eligibility systemsPart of managed care functionality and refers to enrolling within managedcare programs; system is designed for ML-3. Medicaid eligibility isdetermined by eligibility systems9.1.1.1 | 13
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Part 4 - Iowa Medicaid Enterprise

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