Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsX12 files for further processing and rejects all the other files by creating appropriateacknowledgments.eCAMS Claims Receipt Business area uses COTS and distributed system architecture which enablesTeam Noridian to quickly implement new transactions.CR.SS.02eCAMS provides the capability to produce custom EDI reports. These reports are not limited to the following.• Transactions submitted by transaction type• Transactions received by transaction type• Cumulative reports over time to support forecastingDuring loading process, valuable metrics about the file and other meta data information is stored in theeCAMS tables. These tables are then accessed by eCAMS HealthBeat (which is an operations dashboard)to produce various custom reports and perform forecasting and trending of data.CR.SS.03Team Noridian’s solution accepts paper claims from Medicaid providers. eCAMS accepts the followingpaper claim formats:• Institutional (UB-92, UB-04, CMS 1450 [UB-92])• Professional (CMS 1500)• Dental (American Dental Association [ADA] 1994, 2000, and/or 2004)Team Noridian's solution can be modified to accept state targeted medical care paper billing forms fornon-electronic claims. Emdeon Transform Suite will be used to scan and OCR the medical care paperbilling form. Then the claim will be loaded in eCAMS and tied to the actual image of the paper claim.CR.SS.04All claims and encounters in eCAMS have a unique TCN. TCNs are the single identifier to track andmaintain claims. The TCN contains intelligence to identify the media of the claim (paper, EDI, DDE);invoice type information such as professional, institutional, and dental; the date it was received; and thebatch number information if it was a paper claim.eCAMS accepts claims attachments. These are linked to claims using an attachment control number. Inthe case of EDI transactions, the attachment control number present in the HIPAA file will be used toassociate the attachment with the actual claim TCN. In the case of DDE, attachments can be uploaded inthe eCAMS screens and will be linked to the claim TCN. After linking, the TCN can be used as a uniqueidentifier to retrieve claims and their associated attachments like consent forms, documentation showingmedical necessity, claim adjustments and prior authorization requests. Figure 9.1.3.1-31 displays the TCNfor all claims.9.1.3.1 | 40
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-31. Claims Inquiry Screen Displaying the TCN. TCN helps in better traceability of claimsand their associated attachments within eCAMS.9.1.3.1 | 41
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Part 4 - Iowa Medicaid Enterprise

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