Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsBE1.07.03The eCAMS Reference module provides the online screen functionality with a flexible benefit planadministration wizard, which can be used by authorized users to define EPSDT services for differentbenefit plans.The benefit plan definition includes the eligibility criteria for the plan, the services covered, EPSDTcriteria, applicable plan premiums, the co-pay deductible, and excluded services.When the system receives and processes eligibility and authorization information, it uses the benefit plansdefined in the reference module to assign benefit plans at member level based on eligibility andauthorization factors which will access to different services defined at benefit plan level and will be usedby claims during adjudication.During the eligibility intake process, eCAMS applies and associates benefit plans based on eligibilitycriteria defined for the member, whether for FFS, managed care benefit plans, or other defined plans.BE1.07.04eCAMS provides the functionality to record EPSDT case activities, including logs of notices, servicedue dates, service status, actual service completion date and case notes. EPSDT system can also beconfigured to capture IME/contractor contact details. The comprehensive EPSDT tracking informationcan appear on online screens with links to service details, correspondence data, and claim history, asshown in Figure 9.1.1.1-13.BE1.07.05eCAMS has work flow process systems which will track services provided for members in differentprograms, such as EPSDT, and generate email and letter notifications to the head of household, guardian,foster care workers, or other specific individuals as directed by IME. Correspondence addresses are tiedto the individual, thus supporting different mailing addresses for the member and guardian.eCAMS has the flexibility to define schedules to generate letters or notification based on system events.The eligibility information stored in eCAMS is used for claim and encounter processing based on memberEPSDT details. During claims processing, EPSDT claims are checked against the EPSDT/Immunizationscreening schedule definitions (periodicity schedules), as maintained by the eCAMS Reference businessprocess area, to determine if the schedule was met. This level of schedule tracking allows the system togenerate reminders and notice letters for follow up. eCAMS supports the ability to configure EPSDTprocessing to include claim attachments.All screenings, referrals and treatments for the EPSDT members can be viewed online, as shown inFigure 9.1.1.1-14.9.1.1.1 | 23