Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsCR Claims Receipt Requirements - MMIS A B C D Ed. Member age and or gender restrictions.e. Prior authorization required.f. Modifiers.g. Place of service.h. Co-payment indicators (overrides).i. Eligibility aid category.j. Family planning indicator.k. Claim type.l. Emergency indicator.m. Units of service.n. Tooth number or letter and or quadrant.o. National billing uniform editor code set.p. Care management authorization number.CR1.SS.11 Produce a summary of EDI transmissions daily. Yes YesCR1.SS.12CR2.01CR2.02CR2.03CR2.03.01CR2.04CR2.05CR2.05.01Provide the capability to respond with appropriate acknowledgementtransactions such as the TA1, 997, 999 and 277CA as directed by IME.Accept, record, store and retrieve documents submitted with, or inreference to, claim submission activity including but not limited to thefollowing:a. Operative reports.b. Occupational, physical and speech therapy reports.c. Durable Medical Equipment (DME) serial number, cost and warrantydata.d. Manufacturer's tracking data for implants.e. Waivers and demonstration specific requirements.Receive claim attachments associated with electronic media or paperclaims and auto-archives or forwards to appropriate operational area forprocessing.Accept Medicare crossover claims for Medicare coinsurance anddeductible or Medicare Explanation of Benefits (EOB) claimsattachments.Provide the capability to accept and process Medicare and other carriercrossovers electronically at the claim and line level.Accept prior authorization attachments such as:a. Surgical and or anesthesia reports.b. Medical records.c. X-rays and or images.d. Orthodontic study models.e. LTC prior authorizations.f. Other items required by IME.Accept other claim related inputs to the MMIS including but not limited tothe following:a. Sterilization, abortion and hysterectomy consent forms.b. Manual or automated medical expenditure transactions which havebeen processed outside of the MMIS (e.g., spenddown).c. Non claim-specific financial transactions such as fraud and abusesettlements, insurance recoveries and cash receipts.d. Electronic cost reports.e. Disproportionate share reports.f. Any other inputs required for services under the state's approved plan.Accept and process all standard data that can be submitted on any claimor claim type.Yes No SM 500YesYesYesYesYesYesYesYesYesYesYesYesYesYesSection 9.1.3.1.2,Requirement #CR1.SS.11Section 9.1.3.1.2,Requirement #CR1.SS.12Section 9.1.3.1.2,Requirement #CR2.01Section 9.1.3.1.2,Requirement #CR2.02Section 9.1.3.1.2,Requirement #CR2.03Section 9.1.3.1.2,Requirement #CR2.03.01Section 9.1.3.1.2,Requirement #CR2.04Section 9.1.3.1.2,Requirement #CR2.05Section 9.1.3.1.2,Requirement #CR2.05.019.1.3.1 | 3