Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operations# Feature Iowa Legacy Provider System Team Noridian’s eCAMS System6. Online Inquiry7.Enrollment Processes8. Provider Identification:9. Provider Cross-referencing10. Institutional rates:11. Hold and review:12. Language indicator:Allows inquiry to providers by various searchpaths, including provider number, SocialSecurity, or federal employer identificationnumber, provider name, unique physicianidentification number (UPIN), provider type,provider county, provider type within county andDrug Enforcement Administration (DEA)number. The inquiry can also be limited to onlyactively enrolled providers or can include allproviders.Online software is used to enroll providers ofservice, which formalizes the procedure forapplication, verification of state licensure andauthorization for claim submission andpayment.The provider subsystem provides a method ofidentifying each provider's type and specialty,as well as the claim types the provider isallowed to submit.• Relate provider to as many as ten providergroups.• Identify an infinite number of memberproviders for a provider group.• Relate provider to as many as ten billingagents.• Identify member providers for a billingagent.• Maintain previous provider number.• Maintain new provider number.• Relate to alternative practice locations orbilling entities.• Identify lien-holder provider number.• Identify provider as managed care alongwith maximum enrolled number ofmembers.• Identify all Medicaid provider IDs related toan NPI.The provider subsystem maintains institutionalrates by charge mode, level of care andeffective dates.The provider subsystem maintains sixoccurrences of provider review indicators forthe review and suspension of claims for specificdates of service, procedures, diagnoses or typeof service codes.Identifies the different languages spoken in theprovider’s office, including Spanish, Bosnian,Serb and Croatian, Vietnamese and Lao.• Allows up to four simultaneous search criterion values, includingprovider name, system assigned provider number, NPI, Tax ID,provider type, provider specialty, provider city, provider county,multiple alternate identifiers, including legacy MMIS provider ID(s)DEA number, UPIN, and Medicare ID. Searches can be limited toa particular enrollment type and business status (active,terminated, etc.) or it can include all providers.• Frequently used search criteria can be saved and reused at theindividual user’s discretion.• Search results can be exported to Excel for additional analysis.• Online enrollments can be completed by Providers inself-service mode or by authorized IME enrollmentworkers. Online enrollment ensures verification of state licensureand other credentials required for claims submission and payment.• Business process wizard (wizard) technology supportsthe online enrollment process guiding the member through everyrequired step while validating and verifying the information enteredto ensure it is both complete and accurate.• Optional enrollment submission can be done via PDF or XMLapplication. Application forms can be downloaded, completedoffline, and uploaded for verification and submission.Provider type, provider specialty and provider taxonomy are capturedto identify the enrollment credentials required. Allowed claim typesand services are mapped to the provider’s taxonomy throughrelational database tables.• Relates the provider to an infinite number of provider groups.• Identifies an infinite number of member providers for a providergroup.• Relates the provider to an infinite number of billing agents. Thebilling agents must be enrolled in eCAMS.• Relates a billing agent to an infinite number of member providers.• Maintains an unlimited number of previous provider numbers.• Maintain new provider number.• Supports up to 1024 alternative practice location.• Supports an infinite number of billing entities.• Through the integrated Financials subsystem, supportsidentification of multiple lien-holders.• Identifies managed care providers as a unique provider enrollmenttype. Through the integrated Managed Care subsystem, identifiesmaximum and current member enrollments.• eCAMS supports a single provider enrollment for each uniqueNPI/TIN combination regardless of the number of program,provider type, and specialty (specializations) the provider has.eCAMS identifies all providers associated to a single TIN.• Has the capability to support multiple of alternate identifiersallowing cross-referencing to other systems external to the MMIS.eCAMS integrated Rate Setting subsystem maintains rates byindividual provider, taxonomy, eCAMS-defined group, Service,Member or and DRG. All rates include charge mode, level of care andeffective dates.eCAMS provider subsystem maintains an infinite number of providerreview indicators through the use of system-defined groups enteredvia the integrated Reference subsystem. A provider can be associatedto an infinite number of groups. eCAMS also support multiple providerindicators including several types of hold-review indicators.eCAMS captures languages spoken and supports indicators for:• Amharic – Ethiopian• Arabic• Bhutanese• Bosnian• Chinese• Dakota• English9.1.2.1 | 10