Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.2.1-69. EDI Submission Details. eCAMS supports multiple methods of EDI submission — Self-submission methods include Web batch (Option 1), FTP secured batch(Option 2), and Web interactiveDirect Data Entry (Option 3). Providers may also choose to appoint a third-part billing agent orclearinghouse (Option 4).Depending on the choices the provider makes on the EDI Submission Details dialog (Figure 9.1.2.1-69)the wizard will designate additional steps in the enrollment process as required. For providers electing toself submit EDI transactions either through web batch or secure FTP, eCAMS will require that theprovider specify the software product and protocols they use for EDI transactions. Having this level ofdetail available on the provider database, IME has the information needed to facilitate EDI-relatedproblem resolution and troubleshooting.If the provider chose Billing Agent/Clearinghouse in the dialog shown in Figure 9.1.2.1-69, they mustcomplete dialogs identifying the billing agent or clearinghouse and designate outbound transaction receiptpermissions for the billing agent/clearinghouse. eCAMS allows providers to delegate authority for receiptof outbound EDI transactions. In the delegation process, the provider selects the billing agent and theoutbound transactions that the billing agent may receive on the provider’s behalf. The provider can alsoname specific contacts designated to handle questions or issues about one or more selected EDItransaction. EDI contact information may be designated as required or optional depending on theDepartment's policies.All EDI-related data can be collected during the enrollment process. The exact same features are availablethrough post-enrollment maintenance functions. An authorized provider enrollment user can add orchange EFT and EDI features at any time at the request of the provider.PR3.SS.01eCAMS interfaces with the SSA Death Registry. eCAMS performs confidence matching to determine ifthere is an exact match or suspected match based on SSN, full name, and address. If there is an exactmatch and the provider is not already terminated, eCAMS automatically terminates the provider'senrollment effective on the date of death reported. eCAMS notes the SSA as the source of the action andprovides the reason code of "11 - Terminate/Deceased" as shown in Figure 9.1.2.1-70. For a suspectedmatch, eCAMS issues an alert to the provider enrollment unit. The authorized provider enrollmentspecialist reviews the information may either complete approve and apply the termination status or rejectit if it is erroneous.9.1.2.1 | 83