Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsOur agile development approach includes development of business areas of systems functionality initerations throughout the development phase. Training will be conducted to coincide with user acceptancetesting of each business area to ensure staff from the Department and other IME contractors have therequisite systems knowledge to perform testing. Training materials will be updated and enhancedthroughout the user acceptance testing phase to reflect system changes or changes of process inpreparation for training all operational staff.Team Noridian has proposed an early roll-out of provider management functionality. Doing this roll-outearly not only allows the provider community the opportunity to take advantage of enhanced systemsfunctionality prior to the full operational go-live date, but also creates the opportunity for a staggeredtraining approach. Training of the provider services contractor on the systems functionality associatedwith this early roll-out limits the scope of training taking place immediately prior to the implementation,reducing risk associated with a big bang implementation and associated knowledge transfer.As shown in Figure 7-10, we will train all contractors on specified areas of the MMIS that are relevant totheir work responsibilities.IME Components and ResponsibilitiesDHS Policy Administration Unit• Responsible for Medicaid Policies that govern Medicaid services in eachprogram areaMember Services Unit• Member enrollment, inquiry and relations, outreach and educationMedical Services Unit• Medical support, prior authorization, HITPharmacy Medical and Pharmacy POS Unit• Pharmacy claims processing, pharmacy prior authorization, drug rebatesProvider Cost Audit Unit• Rate setting, cost settlement, cost auditsProvider Services Unit• Provider enrollment, inquiry and relations, outreach and educationRevenue Collections Unit• TPL recovery, provider overpayment and withholds, lien recoveryProgram Integrity Unit• Data analytics, SURS, medical value managementData Warehouse Unit• ReportingCore Unit• Mailroom, claims receipt (EDI), claims processing, MMIS, OnBaseTraining• Use of RuleIT rules engine for assessment of current policy andconsideration of policy change• Support for facilitating exception to policy• Use of new MMIS for claims and correspondence retrieval and inquiry• Access to Medicaid and waiver member eligibility through the new MMIS• Support access to Web portal for distribution of member information• Use of new MMIS for claims and correspondence retrieval and inquiry• Use of RuleIT rules engine to automate approval of approved set of priorauthorization requests• Ability to retrieve prior authorization and supporting records for approval• Use of new MMIS for claims and correspondence retrieval and inquiry• Interface to receive pharmacy claims file into the MMIS for payment• Receipt of applicable prior authorizations• Use of new MMIS for claims and correspondence retrieval and inquiry• Retrieval of checks and related images• Access to historical data in new MMIS• Updating accounts receivable and accounts payable• Use of new MMIS for claims and correspondence retrieval and inquiry• Receipt of provider enrollment applications and updates• Maintenance of provider file• Access to Web portal for provider transactions and outreach• Use of new MMIS for claims and correspondence retrieval and inquiry• Retrieval of checks and related images• Access to historical data in new MMIS• Updating accounts receivable and accounts payable• Use of new MMIS for claims and correspondence retrieval and inquiry• Receipt of SURS and related reports• Use of new MMIS for claims and correspondence retrieval and inquiry• Receipt on claims data• Use of new MMIS for claims and correspondence retrieval and inquiry• Claims adjudication and adjustment processes• Receipt, imaging and indexing, and retrieval of images• New MMIS reference file updates• Configuration of new rules to support changes in policy• Use of new MMIS for claims and correspondence retrieval and inquiryFigure 7-10. IME Training Summary by Unit. As the MMIS and Core MMIS operations contractor, TeamNoridian will provide eCAMS training that is customized to the business functions of each unit.7 | 38