Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operationsfeed eCAMS HealthBeat which is and operations dashboard that will provide the metrics and status ofEDI transactions processed by eCAMS.CR1.18eCAMS has the ability to do mass adjustment, resurrection, and recoupment of claims. Figure 9.1.3.1-22displays the screen where the user can define criteria to initiate a mass adjustment batch request and thenchoose an action: adjustment, resurrection, or recoupment.Figure 9.1.3.1-22. Mass Adjustment/Resurrection Initiation. eCAMS allows the users to upload a list ofTCN’s which increases efficiency.eCAMS provides a capability for the user to review the impacted claims before applying the change.After the mass adjustment batch is initiated, the user can choose to hold the claims for review beforefinalizing the change. The user can then further approve or reject the adjustment at each claim level.Please refer to our response to Requirement CA1.19 above for details.A user can also initiate a gross adjustment (i.e., pay out or recoupment) using the gross adjustmentscreens. Figure 9.1.3.1-23 depicts a similar screen in eCAMS with various options, such as payout, takeback, and cash application.9.1.3.1 | 28
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-23. Gross Adjustment Initiation. eCAMS provides the Gross Adjustments functionality toenable easy processing of non-claim transactions.CR1.SS.01eCAMS claims business process area support accepting and loading POS claims from an external source,storing pharmacy claims, displaying them in the eCAMS claims screens and processing the POS claims inthe weekly financial schedule. The eCAMS system will receive the pharmacy claims from the POS on adaily interface after the end of the day. These claims will be loaded into eCAMS using the interfaceloading routines. The design of the POS claims loading interface will be documented in the interfacedesign document and approved by the Department. Typically the POS claim numbers are than the rest ofthe other claims types in the system. The claims loading process will be tuned to handle loading largevolume of claims quickly and create detailed loading reports of warnings and errors during the process.The loaded claims are available in the eCAMS OLTP database and can be queried and view along withthe rest of the claims in the eCAMS database. The Pharmacy claims will be accessible in a view onlymode through the screens. Once the POS claims are loaded they will be processed through the accountcode assignment process and marked for the weekly financial payment processing. The claims willprocessed along with rest of the claims in the weekly payment cycle which will create the paymentrecords and generate the RA and 837 documents for the individual providers.CR1.SS.02eCAMS online DDE screens can be used to enter claims online. This screen can be accessed byauthorized Department users to directly enter the claim. Data is edited for validity as it is entered. Errormessages are returned to the user when error conditions are encountered thereby giving the user theopportunity to correct the error at the point of input. This prevents the acceptance of incorrect data intothe system and reduces the need for providers to return to a previous screen to make corrections. Thisfunctionality is successfully implemented in both Washington and Michigan MMIS systems.CR1.SS.03eCAMS records time, date and the user of all the user generated transactions through online screens. Thisaudit log will improve the traceability for any activity performed through online screens. This model issuccessfully implemented in both Washington and Michigan MMIS.9.1.3.1 | 29
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Part 4 - Iowa Medicaid Enterprise

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