Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-21. TOB Test Results Page. Trading partners are given status of their transactions withinmoments of submission of their test file.Submission of test files will not impact production system data because this entire process is occurring inthe test environment. After successful loading and generation of outbound transactions, the provider willbe certified and the mode of claim submission will be modified to “Production.” All providers, aftersuccessful certification, can submit their transactions through the EDI gateway or Web Portal in the newMMIS production system.CR1.17Each claim batch will be assigned a status on entry into eCAMS. If all the claims in the batch are loaded,then the status of the batch will be “successfully loaded.” If the batch is not loaded or partially loaded,periodic monitors will help identify the batches with these statuses. These batches will be recovered afterfixing or bypassing the error, and eCAMS has the capability to load only the claims that were not loadedduring the previous time.CR1.17.01eCAMS produces acknowledgment transactions like TA1, 999, and 997 on receipt of inbound EDItransactions (837, 270, 276, 278). These acknowledgment transactions will be sent to the submitter ofan EDI claim which will provide information on the number interchange segments (ISA-ISE), groupsegments (GS-GE) and transaction sets (ST-SE) that are successfully accepted and rejected. Reject reasoncodes along with the reason for rejection will be present for rejected transactions. EDI files that fail inSNIP Type 1 and/or SNIP Type 2 validation are rejected at the Transaction Set (TS) level rather than theGroup Sender (GS) level. This ensures that, rather than rejecting all the claims within the GS, the numberof claims rejected is kept to a minimum. Since the claim count is present within the TS, using thetransaction acknowledgment status the submitters can verify the number of claims accepted and rejectedby the Department against the total claims submitted by them.CR1.17.02eCAMS audits all the EDI transactions right from the point of receipt into eCAMS. This audit logprovides valuable information like the submitter, transaction type, file name, file size, date and time thefile was submitted, status of the transaction (like successfully validated, translated, loaded etc), number ofbusiness units (claims) present in the file and acknowledgment status. This log information is also used to9.1.3.1 | 27