Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsCR2.05eCAMS accepts multiple attachment forms related to sterilization, abortion, and hysterectomy consentforms. Manual or automated medical expenditure transactions that have been processed outside of theMMIS will be accepted in both paper and electronic format. Team Noridian’s solution accepts non-claimspecificfinancial transactions such as fraud and abuse settlements, insurance recoveries, and cashreceipts. Reports related to electronic cost and disproportionate share will be accepted by the claimsreceipt business process area.eCAMS also accepts other attachments and claim inputs related to drug rebate and very low birth weights.Emdeon Suite is used for imaging and OnBase EDMS stores the electronic images. These attachmentswill be made available during the adjudication of the claim using eCAMS screens. Team Noridian willwork Department staff to identify other inputs required for services under Department's approved plan.CR2.05.01eCAMS accepts all types of claims, adjustments, and attachments. eCAMS stores all the information fromthe input as either processing or situational. Processing elements are used by Department for adjudicationof a claim. Situational elements (e.g., billing provider address) are information that may not be used byDepartment for adjudication of claims. eCAMS stores the situational information and facilitates an onlinescreen to view the situational information. All attachments are processed by our Emdeon Suite imagingsystem and linked to associated claims, and can be viewed from claims screens.CR3.01eCAMS supports the following X12 4010 and X12 5010 HIPAA EDI transaction sets as required by 45CFR Parts 160 and 162.• 270 – Eligibility, coverage, or benefit inquiry• 271 – Eligibility, coverage, or benefit information• 276 – Electronic claim submission system request• 277 – Electronic claim submission system response• 834 – Benefit enrollment and maintenance• 835 – Healthcare claim payment advice• 837D – Healthcare claim — dental• 837I – Healthcare claim — institutional• 837P – Healthcare claim — professional• 997 – Functional acknowledgment• 999 – Functional acknowledgment• TA1 – Interchange acknowledgment• 278 – Prior Authorization Request• 278 – Prior Authorization ResponseeCAMS accepts coordination of benefits data in an 837 transaction and accepts crossover claims fromCOBCs. As discussed in response to CR2.01, Team Noridian’s solution can be modified to accept X12HIPAA 275 transactions to accept claims attachments. At this time, the 275 standard is only published asa NPRM. Once the 275 transaction is mandated, Team Noridian will work with Department to determinea suitable timeframe (based on the agreed upon project work plan) for implementation.CR3.01.01eCAMS accepts 837 P/D/I encounter files. The EDI Services-eCAMS loading process loads the encounterdata into MMIS. The loaded encounters are run through further business processes and an EncounterTransaction Response Report is sent to the submitters of encounters. These encounters can be accessedthrough eCAMS online screens.9.1.3.1 | 34
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsCR3.02eCAMS provides secure, Internet-based HIPAA-compliant functionality to upload EDI files. Providerscan access these online functionalities using SSO and HTTPS (Secure HTTP) protocol. Trainingdocumentation is provided on the Web and it includes provider billing instruction and trading partneragreements (TPA). Figure 9.1.3.1-27 identifies such user instructions developed and made available overthe Web for the Michigan MMIS implementation. Figures 9.1.3.1-28 and 9.1.3.1-29 demonstrateproviders’ ability to upload HIPAA EDI files through eCAMS online screens.Figure 9.1.3.1-27. Support for Provider Companion Guides and Trading Partner Agreement (TPA)Instructions on the Web (Sample from CHAMPS). Team Noridian’s experience developing documentationwill offer enhanced clarity on HIPAA EDI implementation.9.1.3.1 | 35
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Part 4 - Iowa Medicaid Enterprise

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