Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsBE.SS.11The claims adjudication module within eCAMS works on a first in, first processed basis. As such, thespenddown for claims in the medically needy file will be applied on a first in, first processed basis.BE.SS.12eCAMS associates all of the members comprising a case to one another. During the claims adjudicationprocess, the ability to determine if a claim belongs to a case where the head of household is enrolled as aspenddown client is available. Once identified, the payment amount of the claim can be applied againstthe spenddown amount of the case head.BE.SS.13eCAMS processes eligibility information using interface and will store medically needy spenddownamounts and other authorization information in the system. DDE screen functionality allows authorizedusers to view spenddown details of claims which have been processed against member eligibility details.BE.SS.14eCAMS receives and processes member eligibility information multiple eligibility sources via interfacefor batch files, real-time updates using web-service framework and through DDE screen functionality forauthorized users.Once the system applies Medicaid eligibility information for a member, the system will allow authorizedusers to view certification history of member Medicaid eligibility periods.BE.SS.15Team Noridian will configure business rules in eCAMS so during the claims adjudication process, theserules will be utilized for applying the unpaid portion of Medicare crossover claims to the outstandingspend down amount of a client.BE.SS.16eCAMS EXACT interface framework supports receiving files from external systems and records all theapplied, error and rejected records. eCAMS generates email error notifications to Department-defineddistribution lists and generates scheduled control reports showing the number of records processed, andthe number of error records per interface. eCAMS also generates a daily member level error report whichshows all details for all error records from each eligibility interface.BE.SS.17Reversal or adjustments of paid claims will result in the spenddown amount maintained on the MMISeligibility tables being restored by the amount of the original claim payment.BE.SS.18eCAMS supports secured real time interaction with POS using web service framework to verify membereligibility as directed by IME. Team Noridian has implemented a proven real time POS interface for theeCAMS system servicing the State of Washington. We will modify the interface to meet the needs IME.Team Noridian will work with IME during the DDI phase of the contract to explore the possibility ofallowing the exchange of spenddown information to occur in a real-time environment.BE.SS.19eCAMS processes eligibility data, EPSDT data, provider data and other defined details from multiplesources and stores all other information as defined in above requirement in member module. It also allows9.1.1.1 | 58