Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsUsers are able to accept what the system extracted, or change the value. After verification is complete,the extracted data from claims will be uploaded into eCAMS for processing. Extracted data along withclaim images will also be sent at the same time to the OnBase system. Users will be able to view claimsand attachments from the eCAMS claims screen by clicking a link that will launch the image(s) fromOnBase allowing a seamless experience for the user.Multiple control reports are in place which will trigger alerts to operations staff on any failures duringloading. These reports will provide information about the nature of the failure and the count of businessunits affected due to the failure. These validations will ensure that the claims are loaded as per the servicelevel agreement by the Department and appropriate information are provided to the Department in case offailure. These control reports are part of eCAMS implementation in Washington and Michigan.CR1.02Team Noridian has extensive experience in Washington and Michigan interfacing eCAMS withdesignated entities like providers, billing agents, POS systems, CMS feeds, and other business-tobusinesspartners. We have created numerous interfaces in both our implementations. The use of aninterface-based strategy allows Team Noridian the ability to implement these interfaces during the startupand implementation phase. These interfaces are managed by the enterprise service bus (ESB) andorchestration engine, EXACT. The use of EXACT automates the execution of the interfaces based on thefrequency with which they are required to be executed during operations. EXACT manages the executionof interface files sent by external systems to ensure that the interface is executed on time and successfullytransmitted to the receiving system. It also controls the receipt of interfaces from systems external toeCAMS by monitoring for the presence of the inbound interface at the time it is expected. EXACTcontinues to monitor for the interface for some predetermined period of time, which can vary by interface.If the interface is received during the period, EXACT will transfer the interface file into eCAMS where itis loaded into the appropriate eCAMS business process area. If the interface is not generated by eCAMSor received by eCAMS within the allocated time period, the system will notify the system operations staffthat there may be a problem with the interface. The system operations staff are able to view EXACTprocessing statistics through our dashboard, HealthBeat such as if an interface is successfully transferredfrom eCAMS or successfully received for loading to eCAMS.Team Noridian will use its experience in the areas of interfaces in Washington and Michigan to integrateeCAMS with the designated entities as required by the Department.CR1.02.01All claims and encounters are assigned a unique transaction control number (TCN). TCNs are the singleidentifier to track and maintain claims. The TCN contains intelligence to identify the media of the claim(paper, EDI, DDE); invoice type information such as professional, institutional, and dental; the date it wasreceived; and the batch number information if it was a paper claim.eCAMS accepts claims attachments. These are linked to claims using an attachment control number. Inthe case of EDI transactions, the identifier present in the HIPAA file will be used to associate theattachment with the actual claim TCN. In the case of DDE, attachments can be uploaded in the eCAMSscreens and will be linked to the claim TCN. After linking, the TCN can be used as a unique identifier toretrieve claims and their associated attachments in eCAMS EDMS. TCN is also used for linkingadjustments and their associated claims (Parent TCN). Figure 9.1.3.1-7 displays the TCN for all claims.9.1.3.1 | 12
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-7. Claims Inquiry Screen Displaying the TCN. Assigning a TCN helps in better traceabilityof claims and their associated attachments within eCAMS.CR1.03Current institutional paper billing forms developed by the National Uniform Billing Committee (NUBC)(UB-04) will be scanned and converted to electronic image like any other claim form in eCAMS. TeamNoridian uses the Emdeon Transform Suite Document Imaging and OCR/ICR to process images ofhandwritten, typewritten, or printed text from the UB-04, CMS 1500, and ADA claims forms into textfiles. This text file is fed into eCAMS, and the eCAMS EDI Services uploads this text file into theeCAMS claims table. Figure 9.1.3.1-8 identifies the overall flow of the paper claim, adjustments, andvoid forms and supporting attachment documents through the scanning and imaging process.9.1.3.1 | 13
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Part 4 - Iowa Medicaid Enterprise

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