Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-3. Claims Receipt Conceptual Architecture. The eCAMS Claims Receipt solution is robust,highly scalable, and based on a service-oriented model using distributed systems architecture.Team Noridian’s solution aligns with the MITA architecture. The eCAMS Claims Receipt businessprocess area is under the Operations Management business process of the MITA business architecture.EDI Gateway. The EDI Gateway is a secure FTP site where providers can submit electronic claims andadjustments. The EDI Gateway handles receipt of all EDI HIPAA batch transactions into MMIS.Following is the list of EDI formats in which claims and adjustments are accepted in eCAMS:• 837 Institutional 4010A and 5010 (fee for service, encounters, crossover)• 837 Professional 4010A and 5010 (fee for service, encounters, crossover)• 837 Dental 4010A and 5010 (fee for service, encounters, crossover)On successful trading partner registration, each provider will be granted access to EDI Gateway.Submitted claim files are transferred from the secure FTP to an internal file server. Acknowledgmenttransactions such as the TA1 and the 997 and 999 will be accessible to providers in the EDI Gateway for9.1.3.1 | 8