Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operationsmodified to accept X12 HIPAA 275 transactionsfor accepting claims attachments. At this time,the 275 standard is only published as a notice ofproposed rulemaking (NPRM). If 275s arepublished as a final rule prior to contractsigning, Team Noridian will implement the 275as part of MMIS. Figure 9.1.3.1-26 shows theattachment flow.CR2.02Team Noridian’s solution accepts attachmentsfor electronic and paper claims. OnBase is usedto store images of claims attachments. Theseimages will be accessible to the adjudicationstaff through eCAMS screens. Attachments arescanned using Emdeon Transform Suite andarchived in OnBase. Scanned images areforward to the appropriate operational area forprocessing. If the clarity of the image falls belowestablished limits, it will be forwarded to manualverification and correction. A workflow processis in place that will trigger communications backto submitters of attachments to rectify the errorand/or send acknowledgments for successfulreceipt of attachments.CR2.03eCAMS accepts Medicare and MedicareAdvantage plan crossover claims andMedicare EOB claims attachments. The EmdeonTransform Suite solution creates the electronicimages and OnBase workflow managementsolution indexes the electronic images and storesthe attachments. These attachments are linked tothe claims within the established service levelmetrics by the Department and can be retrievedfrom the eCAMS screens.Figure 9.1.3.1-26. X12 275 ConceptualAttachment Flow in Team Noridian’s Solution.The addition of X12N 275 enables theDepartment support of clinical interoperabilityand encourages providers to move towardelectronic transmission of healthcare claimsand related attachments.CR2.03.01As mentioned in CR2.03, eCAMS accepts Medicare crossover claims which consists of both claim headerand claim line. eCAMS also accepts crossovers from other carriers electronically. Crossover receiptfunctionality is successfully implemented in both Washington and Michigan.CR2.04eCAMS accepts prior authorization attachments such as surgical/anesthesia reports, medical records, x-raysand images, and any other attachments that are required by State and federal rules. Attachments related toprescription drugs and orthodontic study models will be accepted in accordance with the Departmentspecification. Emdeon Suite is used for imaging and OnBase EDMS stores the electronic images. Theseattachments will be made available during the adjudication of the claim using eCAMS screens.9.1.3.1 | 33