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 9.1.3.1-9. eCAMS Operations Dashboard. The eCAMS claims dashboard enables operations staffto be more efficient and to respond quickly to any issues/opportunities.CR1.07All claims in eCAMS will be associated with its claim source code (Paper, EDI, and DDE). This claimsource code will help identify the input source of the claims. Input sources include EDI Batch, DDE,paper, and EDI File Upload. This source code is used in control reports to reconcile with the claim countfrom the subsequent processes and help perform input source-specific editing. This source code alsoprovides an audit trail of the input of these claims and can help generate source-specific audit reports.Figure 9.1.3.1-10 shows where the claim source is displayed.9.1.3.1 | 16
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-10. eCAMS Screens Displaying Claim Source. The eCAMS screens are designed based onprinciples of User Interface Design (UID); “claim input source” is identified as a key element that needsto be visible (the Visibility Principle of UID) to the user in the header section of claims screens to ensureclaim source traceability.CR1.08Team Noridian’s solution includes Emdeon Transform Suite, which orchestrates the optical characterrecognition (OCR), intelligent character recognition (ICR), and optimal mark recognition (OMR)capabilities for claims, adjustments, and voids. If OCR for a claim falls below the defined confidencelevel, the claim is manually pre-edited. This confidence level validation and editing can be performed onany claims field and includes provider ID, provider NPI, member ID, procedure codes, and diagnosiscodes. After pre-editing, electronic text of the claim is created and sent to the EDI Services – eCAMSLoading Process, where the claim fields, subject to validation against loading business edits, are loadedinto eCAMS.CR1.09Team Noridian’s solution uses Emdeon Transform Suite, which is an industry proven product to produceelectronic images of all hard-copy claims, adjustments, voids, and related documents. Appropriate controlprocedures are in place to check the image count against the count of forms received in the system.Emdeon Transform validates the electronic image against established quality standards in terms of clarityand accuracy. Any images failing to meet establish quality standards will be subject to manualintervention and correction. The Emdeon Suite with Emdeon Transform autocorrects skewed documentsup to 20 degrees of skew and adjusts document resolution. Team Noridian sets document resolutions9.1.3.1 | 17
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Part 4 - Iowa Medicaid Enterprise

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