Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFeatures and Benefits of eCAMS Provider Business AreasSelf-service provider portal dedicated to providers• Reduced provider call volumes and written inquires• Faster throughput for new application and re-enrollments• Improved level of service to providers through 24x7 access to IME provider services• Accurate provider recordsRules engine-based credentialingBusiness process wizards for enrollment andmaintenanceLook and feel very similar for providers and IME• Faster implementation of policy changes• Consistent application of enrollment policy through wizards• Easy to use, step-by-step process with built-in validation and feedback to ensure complete andaccurate information before submission to IME• More complete and accurate applications and maintenance requests that are easier and fasterto process• Easier to help providers with questions• Easier to maintain consistency among authorized users entering dataAbility to define State-specific taxonomies/PTSPs• Easy to support traditional and nontraditional provider enrollment processesIntegration with Medicaid Incentive Payment Program• eCAMS has all of the hooks and data elements necessary to track provider’s participation in theState’s electronic health records Medicaid Incentive Payment ProgramSingle enrollment for all of a provider's relationships withIME• eCAMS integrated provider database allows a provider to enroll with multiple provider types andspecialties under a single enrollment record virtually eliminating duplicate provider conditions• Reduced maintenance as changes entered can be applied to one or many relationships theprovider may have with IME• Easier, consolidated maintenance• More accurate and current dataFigure 9.1.2.1-10.Provider Management Business Area Features and Benefits. eCAMS brings timeefficiencies to the critical Provider Management function.Interfaces ListingeCAMS supports a number of interfaces in support of the Provider Management business area as shownin Figure 9.1.2.1-11 and Figure 9.1.2.1-12. Figure 9.1.2.1-11 shows eCAMS external interfaces andFigure 9.1.2.1-12 shows internal interfaces.External Interfaces# Interface Name Interface Description Source Destination Requirement #1. Death information2. B-1 Reporting3. Bank Reconciliation File4. IDPH License Files5 MMIS Providers FileThis file contains Death information from the DeathRegistry. It is accepted into eCAMS Provider businessarea via FTP transmission on a weekly basis.This file is the B-1 Reporting which is sent to the EmailTo User. It is transmitted from the eCAMS Providerbusiness area via e-mail transmission on an On Receiptbasis.This file is the Bank Reconciliation File which is sent tothe Check Write System. It is transmitted from theeCAMS Provider business area via Connect Directtransmission on a weekly basis.This file is the IDPH License Files which is sent to theCOLD/DIP Server. It is transmitted from the eCAMSProvider business area via FTP transmission on amonthly basis.This file is the MMIS Providers File which is sent to thePharmacy Data Warehouse. It is transmitted from theeCAMS Provider business area via SFTP transmissionon a monthly basis.Death RegistryMMISPR3.SS.01PR2.05.01PR3.01OnBase Email To User PR4.SS.04MMIS Check Write System N/AMMIS COLD/DIP Server N/AMMISPharmacy DataWarehousePR1.SS.029.1.2.1 | 24
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsExternal Interfaces# Interface Name Interface Description Source Destination Requirement #6. Provider 1099 TapesThis file is the Provider 1099 Tapes which is sent to theIRS. It is transmitted from the eCAMS Provider businessarea via FTP transmission on a yearly basis.MMIS IRS PR2.05.017. Provider Address FileThis file is the Provider Address File which is sent to theIME Server. It is transmitted from the eCAMS Providerbusiness area via FTP transmission on a daily basis.MMIS IME Server N/A8. Occupational LicensingThese files contains occupational licensing information tobe applied to the provider databaseOccupationalLicensing Boardsto be IdentifiedMMISPR.SS.12PR3.019.Iowa Health InformationExchange (HIE)This file will contain HIE provider data to be matched withand applied to the provider database.Iowa HIEMMISPR.SS.13PR3.0110.Iowa Statewide ProviderDirectoryThis file contains statewide provider directory data to bematched with and applied to the provider database.To be determined MMISPRSS.13PR3.0111. Medical LicensingThis file contains professional and institutional medicallicense information to validate and update the providerdatabase.Iowa Board ofMedicineMMISPR.SS.13PR2.05.01PR3.0112.CMS Excluded ProviderList(OIG List of ExcludedIndividuals and Entities)This file contains individuals and organizations who aresanctioned by the Office of the Inspector General.OIGMMISPR1.02.04PR1.02.10PR2.05.01PR3.0113.Online SurveyCertification andReporting (OSCAR)This file contains Clinical Laboratory Improvement Act(CLIA) information to validate laboratory providers andrelated claims.OSCARMMISPR2.04.01PR2.04.02PR2.05.01PR3.0114.National Provider andPayer EnumerationSystemNational Provider Identifier (NPI) validation andverification.NPPESMMISPR2.05.01PR3.0115.Drug EnforcementAgency (DEA)Valid DEA numbers for verification of provider database. DEA MMISPR2.05.01PR3.0116.Bank Account andRouting NumberInformationThis is a bidirectional interface between eCAMS and theState Payment System to establish new providers and tomaintain current payment status information in theprovider database.MMISState Payment SystemPR2.05.01PR3.0117.18.State SanctionedProvidersNational Association ofBoards of PharmacyThis is a new interface to accept information from statesanctioning organizations to update the providerdatabase.To Be Determined MMISNABP Numbers for provider validation and verification NABP MMISPR1.02.10PR2.05.01PR3.01PR2.05.01Figure 9.1.2.1-11. eCAMS External Interfaces. The Provider Management business area interacts with anumber of external business partners.Internal Interfaces# Interface Name Interface Description Source Destination Requirement#1.2.eCAMS Correspondencefor OnBase Vault KeysOnBase CorrespondenceVault KeysWhen eCAMS generates correspondence to aprovider, the correspondence will be passed to theOnBase and cataloged in the EDMS.This interface carries two kinds of information. First,when new eCAMS-generated provider documents arecataloged in the EDMS, OnBase will pass theappropriate vault retrieval key information to theeCAMS database to allow for in-context retrieval in theProviderSubsystemOnBasePR1.02.08OnBase Provider Subsystem PR1.02.089.1.2.1 | 25
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Part 4 - Iowa Medicaid Enterprise

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