Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operations# Group Processes eCAMS Alignment eCAMS MITA Maturity Level (ML) Compliance/Notes4 Member Management Manage Member Data Yes ML-35 Member Management Inquire Member Yes ML-36 Member Management7 Member Management8 Member ManagementPerform MemberOutreachManage MemberCommunicationManage MemberGrievance/AppealYesYesYesOperational service; tools are available within the system to supportoutreach function; system is designed for ML-3ML-3System designed for ML-3 (Case Management business process areacapabilities in the system support this feature)Figure 9.1.1.1-3. MITA Business Services Alignment for Member Management. Our solution is alignedwith both the Department’s member management business process area requirements and applicableMITA business process areas.List of Member Management Reports in eCAMSFigure 9.1.1.1-4 is a table listing all the member management related reports. The capability to producethose reports exists within eCAMS. In addition to these reports there are several other membermanagement reports that are categorized as Operations management reports which are part of eCAMSreports but not included here.# Report Name Description Available in eCAMS New Report Requirement#1 Eligibility Report Member eligibility reconciliation report Yes No BE1.SS.11, BE.SS.192 EPSDT Report EPSDT services covered under Medicaid Yes No BE1.073 Audit trail reports Member Audit trail report for batch and real-time Yes No BE1.11.01, BE2.SS.044member lock-in statusreportMember lock-in status report No Yes BE2.SS.085Medicare serviceReportMedicare service bought by Member in anotherstateNo Yes BE5.SS.04Figure 9.1.1.1-4. Proposed eCAMS Member Management Reports for IME. Table-driven data facilitatesrobust reporting capabilities while exportable list pages enable on-demand reporting of search results.Correspondence ListFigure 9.1.1.1-5 provides various correspondence options available within eCAMS to satisfy specificIME requirements. In addition to these examples, other configurable correspondence options are availableto meet IME business needs.# Correspondence Title Description Available in eCAMS New Letter Requirement#2 EPSDT screenings letters EPSDT screenings letters Yes No BE1.07.053Certificates of creditablecoverage4 Privacy notices5 Notices of Decision6 Spend down NoticesGeneratecertificates of creditablecoverage lettersGenerate Privacy practicenoticesGenerate notices of Decisionletters to MembersGenerate notices to providerand member of claim amountsapplied to spend down andamount of unmet spend downYes No BE4.SS.01Yes No BE4.SS.02No Yes BE1.02.02No Yes BE.SS.05Figure 9.1.1.1-5. Proposed eCAMS Member Correspondences for IME. Our DOC1 solution providespowerful on-demand and scheduled correspondence capability which is seamlessly integrated with ourdocument management system for instant retrieval of prior correspondence.9.1.1.1 | 14