Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsTaken together, Figure 9.1.2.1-4 and Figure 9.1.2.1-6 show how eCAMS completely supports theProvider Management business process area with a MITA-aligned solution that will position theDepartment to meet its objectives, including:• Early deployment of provider enrollment functions (this is not an RFP requirement, but is beingproposed by Team Noridian based on positive experience in other states)• Online Web capabilities for all users, including providers. eCAMS offers a unique provider portalthat allows providers to access many services 24 hours a day, 7 days a week (24x7). The portalenables them to enter new enrollment applications, maintain their provider data, enter and inquireabout claims, enter and inquire about prior authorization (PA), view and download remittanceadvices, and send and receive HIPAA transaction sets.• User-friendly rules engine-based structure to support credentialing and provider enrollment/reenrollment policies.• Excellent audit trail features identifying who initiated the change, what changed, when the changewas requested, who approved/denied the change, and when it was approved or denied.• Outstanding filtering and inquiry capabilities allowing authorized users to search for and retrieveprovider information based on user-supplied search criteria.• Compliance with and use of the National Provider Identifier (NPI) for provider enrollment and claimsadjudication is a native feature of eCAMS.• Automatic assignment of atypical provider IDs for providers who are not eligible for NPIs.• Full integration with the Case Management business process area to support provider grievancesand appeals.Overall, eCAMS Provider Management business process area benefits the Department by modernizingand streamlining the many paper and manual processes used in the legacy environment, whilesubstantially increasing the ability to respond to provider requests and improve customer service. eCAMSreplaces the Department’s multiple provider files with a single database capable of managing enrollmentand interrelationships of all types of providers. eCAMS centralized database virtually eliminates duplicateenrollments using a single master record to contain all relationships the provider may have with IME.Even if a provider has multiple provider types, eCAMS retains the information under a single enrollmentthat is permanently linked to the provider’s unique NPI and Taxpayer Identification Number (TIN).eCAMS Provider Management business process area is functionally divided into four major features areaswhich are:• Initial Provider Self-service Enrollment• Online Self-service Provider Portal (Web Portal)• Provider Enrollment and Maintenance Administration• Provider Business Rule Maintenance and CredentialingIn the remainder of this overview, we present a discussion of each feature area.Manage Initial Provider EnrollmentThe interactive online enrollment application provides structured, online screens with the businessprocess wizards that guide the provider step-by-step through the eCAMS enrollment process. Theprovider may begin an application and keep working on it for several days or weeks. The eCAMS wizardmaintains the state of the application and allows the provider to continue exactly where the individual leftoff. The wizards are configured to the Department’s standards and fully support IME-specificcredentialing rules. As the provider proceeds through the application, the wizard lists each step requiredand shows which steps have been completed. It allows the providers to navigate, view, and modify anyinformation in the application up to final submission for review and approval. After collecting some basicinformation, eCAMS generates unique application numbers that providers use as reference numbers9.1.2.1 | 15