Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.2.1-79. Manage Provider Rates. eCAMS Rate Setting features support rate setting forindividual providers, groups of providers who share a taxonomy and other modes such as predefinedgroup, DRG, and enrollee.PR.SS.16eCAMS sweeps the provider database on a nightly basis looking for credentials that are nearing expiration.The triggers can be set at the 90-day mark to notify the contractor of upcoming credential expirations.eCAMS automatically formats and sends an internal alert to one or more identified users when the triggercondition has been met. Multiple triggers can be set for a single event (credential expirations).PR.SS.17eCAMS is designed to automatically interface with the OIG LEIE sanctions file. Team Noridian willbuild a new interface to accept information from state sanctioning organizations.PR.SS.18Team Noridian will develop a provider edit to be invoked when entering a "pay-to" address. The edit willdisplay an error message indicating that a non-US address cannot be used for the pay-to location. Thesystem will not allow the pay-to address to be stored.PR.SS.19eCAMS allows multiple provider status codes for the same and overlapping timeframes. Status codes canbe set individually by practice location or managed care contract. Status codes can also be set at thespecialization level. Specialization is the unique combination of program (e.g., ABC Dental) and providertype and specialty (e.g., dentistry/pediatric dentistry). eCAMS architecture supports a single enrollmentfor the provider's unique NPI (or API) and TIN combination. Multiple practice locations may be specifiedunder the single enrollment. Multiple specializations can be defined and associated independently to eachlocation. This reduces work for the provider enrollment specialist at the same time as it provides a verygranular level of control over the provider's relationship with IME.9.1.2.1 | 94
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsPR.SS.20eCAMS maintains inputs and outputs to support all of the required elements. Figure 9.1.2.1-80 shows amapping to the required inputs and Figure 9.1.2.1-81 shows the required outputs.Inputsa. Provider enrollment data.b. Provider demographic changes.c. Provider rate changes.d. State and federal licensing and certification documentation.e. Provider sanction listings.eCAMS accepts enrollment data through direct online data entry, through uploaded PDFenrollment applications, and through XML file submission. Data can be applied to either a newenrollment application or to maintenance of an enrolled provider's database record. Inputs canbe accepted via provider self-service and through IME provider enrollment specialists.eCAMS accepts provider demographic changes through direct online data entry, throughuploaded PDF enrollment applications, and through XML file submission. Inputs can be acceptedvia provider self-service and through IME provider enrollment specialists, and through interfaces.eCAMS accepts provider rate changes through direct online data entry by an authorized user orthrough file upload via the rate setting business area.eCAMS accepts federal and state licensing and certification documentation through interfacesand direct data entry. Automatic validation against the licensing organization is performed for anydata entered online.eCAMS accepts sanction information from the OIG's LEIE interface and is being modified tosupport interface to State sanctioning organizations.Figure 9.1.2.1-80. eCAMS Inputs. eCAMS accepts inputs from a variety of sources to maintain the mostup-to-date provider records.Outputsa. Daily, monthly and on request reports and address labels.b. Daily provider files.c. Produce and deliver to the IME all reports requested by theIME from the provider data maintenance function, at thespecified frequency, medium and delivery destination.eCAMS produces multiple reports including daily, monthly and on request reports. Providerreports are summarized in Team Noridian's responses in section 9.1.2.1.2, Approach toAddressing the Provider Management Requirements, Figure 9.1.2.1-14. Team Noridian willconfigure Address Label reports as a part of standard DDI activity.eCAMS supports daily inbound and outbound provider interfaces and data extracts. Providerinterfaces are summarized in Team Noridian's responses in section 9.1.2.1.2, Approach toAddressing the Provider Management Requirements, Figure 9.1.2.1-11 and Figure 9.1.2.1-12.eCAMS support daily report production. IME will manage the delivery of reports as specified tothe requested destinations.d. Remittance advices in electronic format and X12N 835. eCAMS prepares Remittance Advices in paper, PDF, and X12N 835 formats.e. Annual 1099s, on federally approved forms and mail toproviders.f. Group mailings and provider labels based on selectionparameters such as provider type, zip code, specialty, countyand special program participation.g. Report identifying any providers who have changed practicearrangements (e.g., from group to individual of from onebusiness to another) by provider type as requested by theIME.eCAMS Financials business area prepares Annual 1099 forms.h. Data required for rate setting as required by IME. eCAMS supports multiple types of rates.eCAMS support group mailings based on selection parameters such as provider type, zip code,specialty and program participation.Activities for changing practice arrangements or specializations (provider type) must be reviewedand approved by authorized IME users. Team Noridian will configure a new report, a subset ofthe audit trail report.Figure 9.1.2.1-81. eCAMS Outputs. eCAMS produces multiple outputs to support the daily operation ofthe Provider Management business area.9.1.2.1 | 95
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Part 4 - Iowa Medicaid Enterprise

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