Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsCR1.SS.04eCAMS provides the capability of front-end editing as the data is entered in DDE screens. This front endedit is applicable to key claim parameters like member ID, all types of providers (like billing provider,service provider, referring provider, pay-to provider), service dates, diagnosis codes and procedure codes.This front end editing feature is part of eCAMS implementation in both Washington and MichiganMMIS. Figure 9.1.3.1-24 shows an example of the system error pop-up when a provider enters invaliddate in the “from service date” field on a claim.Figure 9.1.3.1-24. Invalid Date Data Type Editing. eCAMS applies an invalid date edit using an errorpop-up, which is one of the upfront edits that save system time and resources.CR1.SS.05eCAMS accepts following types of electronic claims• Electronic Batch. This is 837 X12 transaction batch transaction.• Individual Electronic. This is 837 X12 transaction with a single individual claim in it.• Paper. Paper claims received go through OCR/ICR processing with a flat file of the extracted databeing electronically submitted to eCAMS for processing.• DDE. Direct data entry claims using eCAMS online screens.All these claims are part of eCAMS implementation in Washington and Michigan.9.1.3.1 | 30
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsCR1.SS.06eCAMS provides functionality for users to define exact duplicate and suspect(potential) duplicate editcriteria, and allows users to manage it online. This configurable definition of criteria support configuringcurrent claim type vs. history claim type as a criterion that lets the user drive the adjudication system toexecute duplicate claim edits across claim types. Because Professional, Institutional, and Pharmacy havededicated claim type codes in eCAMS, duplicate logic that includes services is completely configurable.Figure 9.1.3.1-25 demonstrates how users can select the claim attributes to be included in the suspectduplicate criteria.Figure 9.1.3.1-25. “Possible Duplicate” Criteria Setup. eCAMS possible duplicate criteria options (thecheck boxes) can be configured by a business user via online screens.CR1.SS.07A single claim document consists of a claim header with multiple claim lines. eCAMS accepts claimslines as per X12 implementation guide specifications. If a provider submits multiple lines in a claim, thenall claim lines will be displayed in eCAMS online screen under a single claim to both IME authorizedusers and providers. This is applicable to HIPAA claims submitted through HIPAA transactions, DDE,and paper claimsCR1.SS.08eCAMS processes claims using the continuous flow processing model, meaning that it constantlyadjudicates claims and can define queue priorities. For example, the encounter claim processing can beset to a lower priority as compared with claims that are submitted through DDE. eCAMS can process allclaims, including online claims, in near real-time and is governed by the queue priority. The eCAMStable-driven (Monitor_Server_X_batch table) process allows for the processing of claim/encounters inbatches.CR1.SS.09eCAMS supports the functionality of submitting online DDE claims. Team Noridian will work with theDeparment to identify the list of required waivered services and will create a customized screen (withreduced data requirements) to support online claim submission of waivered services and other entities notcovered by HIPAA.9.1.3.1 | 31
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Part 4 - Iowa Medicaid Enterprise

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