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 ECR.SS.02CR.SS.03CR.SS.04Provide capability to produce custom EDI reports regarding:a. Transactions submitted by transaction type.b. Transactions received by transaction type.c. Cumulative reports over time to support forecasting.Accept and use the state targeted medical care paper billing form fornon-electronic claims.Assign a unique transaction control number to each transaction andcontrol all transactions throughout the processing cycle. Assign thetransaction control number of the claim to all associated attachmentssuch as consent forms, documentation showing medical necessity, claimadjustments and prior authorization requests in a timely manner.YesYesYes No SM 500YesYesSection 9.1.3.1.2,Requirement #CR3.SS.02Section 9.1.3.1.2,Requirement #CR3.SS.03Section 9.1.3.1.2,Requirement #CR3.SS.04As shown in Figure 9.1.3.1-1, Team Noridian has reviewed and analyzed all of the requirements in therelated section of the RFP, and provided an overall summary of how our solution meets the requirementsbased on existing capability and required modification, as well as the total number of DDI hours neededto develop those capabilities not currently existing in the system.Column Column Description Column SummaryColumn A Team Noridian agrees to meet the requirements as stated. 100%Column B Team Noridian's existing capability in eCAMS solution meets the requirements. 93%Column C Team Noridian will modify the eCAMS solution to meets the requirements. 7%Column D Team Noridian's effort to modify the eCAMS solution to meet the requirements. 2300 Effort HoursFigure 9.1.3.1-1. Demonstrated Compliance of Team Noridian’s Solution to the RFP Requirements. Oursolution will meet all of the RFP requirements by either using existing system capability or configuringand modifying the eCAMS system.9.1.3.1.2 Approach to Addressing the Claims Receipt RequirementsThe eCAMS claims receipt business process area provides a robust, comprehensive, and configurablesolution to accept, track, and retrieve health care claims and other EDI transactions and relatedattachments. Team Noridian’s solution is compliant with established HIPAA standards and supports X12versions 4010 and 5010. This solution provides appropriate feedback to the provider communities on thestatus of their submitted electronic data interchange (EDI) batches and direct data entry (DDE) claimsboth through EDI transaction responses (TA1, 997, 999, and 835) and through eCAMS online screens.Overview of Claims ReceiptFigure 9.1.3.1-2 shows the business architecture of eCAMS claims receipt business process area and itsinteraction with other business process area in eCAMS. The claims receipt business process area consistsof the following sub-process areas:• Electronic claims receipt• Non-electronic claims receipt• Attachment receipt• DDE claims receiptAs illustrated in Figure 9.1.3.1-2, this business process area interacts with various other eCAMS businessprocess areas while accepting and loading the claims in eCAMS.9.1.3.1 | 5