§ 25.5-4-204 — Automated medical assistance administration

(1) The general
assembly hereby finds and declares that the agency responsible for the
administration of the state's medical assistance program would be more effective
in its ability to streamline administrative functions of program administrators and
providers under the program through the implementation of an automated system
that will provide for the following:

(a) Electronic claim submittals;

(b) Online eligibility determinations;

(c) Electronic remittance statements;

(d) Electronic fund transfers; and

(e) Automation of other administrative functions associated with the medical
assistance program.

(2) Therefore, the general assembly declares that it is appropriate to enact
legislation, as set forth in subsection (3) of this section, that authorizes the state
department to develop and implement an automated system for processing claims
and payments under the medical assistance program, as well as for other
administrative functions associated with the program.

(3) The executive director of the state department shall develop and
implement an automated system through which medical assistance claims and
payments and eligibility determinations or other related transactions may be
processed. The system shall provide for the use of automated electronic
technologies. The automated system may be implemented in phases if deemed
necessary by the executive director. The automated system shall be implemented
only after the executive director determines that:

(a) Technology is available and proven to perform satisfactorily in a
production environment;

(b) Adequate financing is available to facilitate the implementation and
maintenance of the system. Financing may include, but is not limited to, federal
funds, appropriations from the general fund, provider transaction fees, or any other
financing mechanisms which the state department may impose, and grants or
contributions from public or private entities.

(c) The system has been successfully installed and fully tested; and

(d) Adequate provider training has been provided for an orderly
implementation.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1822, � 7, effective July 1.