Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-28. eCAMS Screen Requesting User to Upload an EDI File. The eCAMS Provider portal issecure, uses HTTPS protocol, and is compliant with HIPAA regulations.Figure 9.1.3.1-29. eCAMS Screen Showing Confirmation of File Upload and Responding with the NextCourse of Actions. Team Noridian’s solution provides real-time feedback to providers on the acceptanceof EDI files.CR3.03eCAMS provides an electronic claims submission solution that allows for a variety of submissionmethods. Providers can submit EDI claims through Secure FTP (SFTP). Providers are also able to submitHIPAA standard claim transactions directly through eCAMS. This is accomplished by uploading aHIPAA batch file. Below are the various types of 837 claims accepted in eCAMS:• Fee for service (Professional/Institutional/Dental)• Encounters (Professional/Institutional/Dental)• Crossovers (Professional/Institutional/Dental)9.1.3.1 | 36
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationseCAMS employs Edifecs for HIPAA validations and it can perform seven levels of editing as outlinedbelow. Team Noridian recommends Levels 1 and 2 to be mandatory while the remaining can be turned tooptional. EDI files that fail in Type 1 and/or Type 2 validation are rejected at the Transaction Set (TS)level rather than the Group Sender (GS) level. This ensures that, rather than rejecting all the claims withinthe GS, the number of claims rejected is kept to a minimum• Level 1: Integrity Testing• Testing valid segments• Segment order• Element attributes• Testing numeric or alphanumeric data elements• Validating X12 syntax and compliance with X12 rules• Level 2: Requirement Testing• Testing implementation guide-specific requirements (e.g., repeat counts; used and unused codes,elements, and segments; required or intra-segment situational data elements such as non-medicalcode sets as laid out in the implementation guide; and values noted via an X12 code list or table)• Level 3: Balancing• Testing field totals• Record or segment counts• Financial balancing of claims or remittance advice• Balancing summary fields• Level 4: Situational Testing• Testing of specific inter-segment situations (e.g., if the transaction is an inpatient claim, a date ofadmission must be present)• Level 5: Code Set Testing• Testing for valid code set values (e.g., CPT, CDT3, NDC, ICD9)• Level 6: Line of Business Testing• Specialized testing required by certain healthcare specialties, such as chiropractic, ambulance,and durable medical equipment• Level 7: Trading Partner Testing• Edits according to implementation guides that are unique and specific to a payer (e.g., Medicare,Medicaid)CR3.04Team Noridian’s mailroom area is responsible for storing all the source documents in secure physicalstorage. Each document is scanned and will have an imprinted unique identifier on the top of each page.This identifier will include the Julian date, scan batch, and page number. As staff start to scan documents,they have a physical box with a unique identifier at the scanning station. The unique identifier of the boxis stored as a keyword on each document. These keywords are made available in OnBase, allowing a userto link an electronic document back to a specific archive box. Using the imprinted information on the topof each page, they can quickly identify within the box the exact pages that they are viewing online. Thecombination of archive box number and the imprinted information allows for staff to locate the archivedsource documents for information retrieval of purging in accordance with the Department specificationand need. The storage and purge process will abide by the rules of HIPAA security provisions.9.1.3.1 | 37
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Part 4 - Iowa Medicaid Enterprise

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