Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsManage Enrolled Provider Information. Enrolled active providers have the ability to maintain the bulkof their provider data through the portal’s self-service maintenance as shown in Figure 9.1.2.1-8 (Feature10). Providers can maintain information such as license information, taxonomy, location updates,payment information, and claim submission information. Once the updates are made by the provider, theinformation is submitted to the provider enrollment unit for review and approval. All updates remain in apending “in-review” status until approved by the enrollment specialist. Once approved, the updatebecomes active immediately. eCAMS maintains comprehensive historical information that can be viewedby providers and IME users thus providing a transparent and auditable system. eCAMS features supportongoing management of provider information, including automatic generation of license renewalreminders to notify providers about license expiration and automatic generation of welcome packages fornewly enrolled providers.Manage Provider Claims. Both billing agents and billing providers have the capability to submitelectronic data interchange (EDI) batch claims and to perform online direct data entry (DDE) of claimsthrough the online screens. The DDE screens are HIPAA-content compliant and support entry ofprofessional (837P), institutional (837I), and dental (837D) claims. The DDE screens support featuressuch as claim templates that aid in faster claim entry. Manage Provider Claims functions are shown inFigure 9.1.2.1-8 (Feature 1).eCAMS supports provider inquiry on claim status and provides the capability to retrieve TA1, 999, and835 remittance advice through self-service online screens. It also supports provider-initiated claimadjustments, resubmission, and claim review requests.Manage Provider Service Authorizations. Providers may enter, submit, and inquire about PA requests.The PA Submission function ensures both the submitting/servicing provider and the recipient are active.This function also verifies that the provider is authorized to perform the requested service and that therecipient is authorized receive the requested service. Providers have the ability to inquire on the status ofthe PA requests and on PA utilization information, such as units used and available, and dollar amountsused and available, through the self-service online screens. Manage Service Authorization features areshown in Figure 9.1.2.1-8 (Feature 2).Inquire Recipient Eligibility Status. Providers have the ability to inquire on the recipient eligibilitystatus through the self-service portal. The online inquiry functionality HIPAA EDI 270-compliant, andthe eligibility response screen is HIPAA EDI 271-compliant. eCAMS supports eligibility inquiry throughWeb services, as currently deployed in Michigan CHAMPS implementation. Eligibility inquiry featuresare shown in Figure 9.1.2.1-8 (Feature 11).Inquire Provider Financial Information. Providers have the ability to inquire on payments, andoutstanding payable and receivable information. This information is available at the Pay-To providerlevel. Payment management features are shown in Figure 9.1.2.1-8 (Features 5 and 8). Providers can alsoview and validate invoices through the portal. Invoice Management features are shown in Eligibilityinquiry features are shown in Figure 9.1.2.1-8 (Feature 4).Self-Administer Provider User Access. eCAMS allows enrolled providers to manage access to theirself-service functions. This feature makes it possible for the provider to make needed access changeswithout having to rely on enrollment unit staff to add or revoke users tied to a provider. These portalfunctions are shown in Figure 9.1.2.1-8 (Feature 10).MCO Features. Several additional provider portal features are available specifically to support managedcare providers. These features include online retrieval and download of encounter transaction resultsreports (ETRRs) using, 820 payment details, and 834 enrollment rosters. 820 premium payments(capitation payments) are shown in Figure 9.1.2.1-8 (Features 5 and 8). ETRRs and 834 enrollmentrosters are shown in Figure 9.1.2.1-8 (Feature 11).9.1.2.1 | 19