Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsCHAMPS and ProviderOne implementations as compared to the IME provider community. eCAMSsupports enrollment of typical, medical providers, both individuals and organizations, who have NationalProvider Identifiers (NPIs). eCAMS also effectively manages provider enrollment for managed careorganizations, billing agents, and atypical providers who may not qualify for NPIs. eCAMS has beencertified for all of the Provider Management business areas outlined under the new CMS MedicaidEnterprise Certification Toolkit, which includes criteria from the State Medicaid Manual, Industry BestPractices, Health Insurance Portability and Accountability Act (HIPAA) and the Code of FederalRegulations (CFR). Team Noridian’s business partner, CNSI, has recent successful certification experiencemapping eCAMS functionality under the new certification tool kit will facilitate rapid and positive resultsfor IME’s Medicaid Management Information System (MMIS) certification process.Provider Metrics IME Provider Community MI MMIS CHAMPS WA MMIS ProviderOneEnrolled Provider Volume 77,000 58,000 56,000Managed Care Organization (MCO) Volume 6 13 33Atypical Providers Yes No YesFigure 9.1.2.1-2. Provider Metrics Comparison — eCAMS Implementations. Comparison to providervolumes in other eCAMS production installations shows that Iowa’s provider population will be easilysupported.In Figure 9.1.2.1-3, Team Noridian provides a feature comparison summary as listed in the Department'sRequest for Proposal, Section 4.1.3 (Provider Function). In this figure, we present the major featuresidentified with a brief summary of how eCAMS supports the stated function.# Feature Iowa Legacy Provider System Team Noridian’s eCAMS System1.2.3.Processes providerapplications and informationchanges interactively usingonline screens, includingimmediate entry, verificationand updating of providerinformation to ensure onlyqualified providers complyingwith program rules andregulations are reimbursed forservices rendered to eligibleMedicaid members.Meets or exceeds all federaland state requirements for aMedicaid provider subsystem.Provider Master FileConfiguration.4. Provider Master File Integration5.Online MaintenanceYesYesSix master files: the provider group file, providerintermediary file, Medicare-to-Medicaid crossreferencefile, provider HMO plan file, and theNational Association of Boards of Pharmacy(NABP)-to-Medicaid cross-reference file.Interfaces with the claims processing, recipient,MAR, SUR, TPL, and EPSDT subsystems tosupply provider data for claims processing andprovider enrollment and participation reporting.• Additions and changes to the providermaster file are processed online and in realtime, they can be verified immediately uponentry. They are also immediately availablefor use in processing claims and othersystem functions.• Edits each field and redisplays the fullscreen with any errors highlighted.YesYes – Certified by CMS under the most recent version of thecertification checklists.One integrated Master File supporting multiple enrollment types,including individuals, groups, facilities, agencies, and institutions,(including pharmacies) managed care Organizations, billing agents,tribal health faculties, and unique, limited enrollment term specialconsiderations providers.Integrated with the claims processing, member, EPSDT, TPL,Finance, subsystems with direct, real-time, database connection forclaims processing, payments, and provider enrollment andparticipation reporting.• Additions and changes to the provider master file are processedonline and in real time, they can be verified immediately uponentry. They are also immediately available for use in processingclaims and other system functions.• Edits each field and provides informational messages to guidecorrections.• Supports separation of duties between data entry and approvalprocesses.• Supports Provider self-service maintenance requests via ProviderPortal.9.1.2.1 | 9