Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsInternal Interfaces3. Provider Address File4. PRV_TB_Transfer (DW14)Provider subsystem. Second, providers or otherexternal entities send provider-related correspondenceor other documents they will be imaged, coded to tie tothe provider's record and the vault keys will be sent tothe provider subsystem for retrieval.This file is the Provider Address File, which is sent toOnBase. It is transmitted from the eCAMS Providerbusiness area via FTP transmission on a daily basis.This file is the PRV_TB_Transfer (DW14), which issent to the Data Warehouse. It is transmitted from theeCAMS Provider business area via SQL transmissionon a daily basis.MMIS OnBase N/AOnBase Data Warehouse N/AFigure 9.1.2.1-12. eCAMS Internal Interfaces. eCAMS Provider Management business area exchangesdata with several business areas within the system.Letters/Correspondence ListingeCAMS generates letters to support the business needs of the IME Provider Services team. Figure 9.1.2.1-13 lists current and planned letters and notices.# Correspondence Title Description1. Letter #7 License Expiring2.Letter #19 Incompleteinformation letterThis letter is automatically generated as aresult of the nightly sweep process. For theDepartment, there are several conditionsthat will trigger production of this letter.The letter is generated on demand by theprovider enrollment specialist where theapplication requires additional information.Available ineCAMSYesNew LetterNoRequirement#PR1.03.01PR2.06PR2.06.01PR2.06.02Yes No PR1.093. Letter #26 Welcome letterThis letter is generated automatically whena provider's enrollment application isapproved by IME.YesNoPR1.03PR1.03.014.Letter #57 DisenrollmentletterThis letter is generated automatically whena provider chooses to disenroll voluntarily.YesNoPR1.03.01PR2.05.015.Letter #59 TaxonomyUpdate letterThis letter is generated automatically whenIME uses the mass update administrationfeature to make changes to the providertaxonomy.Yes No PR1.03.016. Letter #90 Denial letterThis letter is generated automatically whenan enrollment application is rejected.Yes No PR1.03.017.8.9.Letter #109 Information ofProvider Termination sent toClientLetter #111 TerminationletterLetter #113 TerminationLetter due to ExpiredLicenseThis letter is generated on demand whenthe provider's status is inactive. The letteris sent to one or more member.This letter is automatically generated whena provider is terminated due to inactivity.eCAMS is currently configured toautomatically terminate providers after 24months of no claim activity. This timeperiod can be modified to meet theDepartment's policy requirements.This letter is generated on demand when aprovider's business status is "Terminated -License Expired". Team Noridian willmodify the letter to allow automaticgeneration when the system terminates aprovider due to license expiration.Yes Yes N/AYesYesYesYesPR1.03.01PR2.05.01PR2.06PR1.03.01PR2.05.01PR2.06PR2.06.029.1.2.1 | 26
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operations10.Letter #114 TerminationLetter due to OIG ExclusionThis letter is generated on demand when aprovider's business status is "Terminated -OIG Authority". Team Noridian will modifythe letter to allow automatic generationwhen the system terminates a provider dueOIG sanction.YesYesPR1.03.01PR2.05.01PR2.0611.Letter #117 EFT ReadyletterThis letter is generated automatically whenthe provider's banking information hassuccessfully cleared testing through thebank automated clearing house (ACH)process. This letter notifies the providerthat they will henceforth be paid via bankdirect deposit transaction.YesNoPR1.03.01PR2.05.0112. Letter #118 POS Block N/A N/A N/A N/A13.14.15.16.17.18.19.20.Letter #121 PrescriptionDrug Volume SurveyLetter #301 User LoginDetails letterLetter #317 QMT MedicalRequestLetter #318 QMT MedicalSecond RequestLetter #319 QMT DenialComplaint RequestLetter #320 QMT DenialComplaint Second RequestLetter #354 PublicationUpdateLetter #394 POSBlock BatchN/A N/A N/A N/AThis letter is generated automatically whenthe provider's eCAMS Provider Portal logincredentials (domain, user ID andpassword) are created.This letter is generated on demand whenthe IME chooses to undertake a qualityreview of the provider based on a membercomplaint.This letter is generated on demand whenthe provider has already received letter#317 and there has been no response tothe letter. The second request letter canonly be generated one time.This letter is generated on demand when amember has lodged a complaintconcerning denial of service from aprovider.This letter is generated on demand whenthe provider has received letter #319 andthere has been no response to the letter.The second request letter can only begenerated one time.This letter is generated on demand to agroup of providers selected on the ProviderList page. It is used to notify providers ofupdated program publications.Yes No PR1.03.01Yes Yes PR1.03.01Yes Yes PR1.03.01Yes Yes PR1.03.01Yes Yes PR1.03.01Yes Yes PR1.03.01N/A N/A N/A N/A21. Annual Reenrollment LetterThis new letter will be sent to providers onan annual basis to notify them of therequirement to reenroll.NoYesPR3.02PR.SS.0622. First Notification - B NoticesThe first notice is sent to solicit correctname and TIN information.No Yes PR4.SS.049.1.2.1 | 27
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