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 9.1.1.1-14. EPSDT Services Received. Claims will use the EPSDT screening schedule definitions(periodicity schedules) as maintained in the eCAMS reference business process area for trackingimmunization/EPSDT performance against the actual as determined through the EPSDT claims data.BE1.08eCAMS supports indicators meeting the enhanced security needs for members. In eCAMS, certainmembers receiving confidential services are identified via a protected population indicator. For memberswith such an indicator, eCAMS audits every inquiry and any updates made to these member records; thesame types of audits are extended to suppress the member document generation. eCAMS also ensuresdocuments such as the EOMB are not generated for members who have received any confidential servicesduring a reporting period.This protected population indicator is available for use by authorized users to suppress the generation ofdocuments containing member identification for confidential services or other reasons.Figure 9.1.1.1-15 depicts the protected population indicator.9.1.1.1 | 24
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.1.1-15. Protected Information. An easy-to-use protected-population indicator is native toeCAMS for audit, privacy, and security needs.BE1.09eCAMS maintains service utilization, special population, lock-in information, and case managementindicators in its member data repository. The member data model will be extended to house clinical anddisease management outcomes for IME. Figure 9.1.1.1-16 identifies the existing indicators such asduplicate member (in this screen “Client”), PHIPP case, co-pay exemption, restricted provider, managedcare enrolled, lock-in, hospice, EPSDT, TPL, and Medicare status. eCAMS will be modified to addadditional indicators as required to support business processes related to disease management, outcomes,and high-dollar case management files. Team Noridian will collaborate with the Department to define thesource data for new indicators.Figure 9.1.1.1-16. Special Indicators on Member Information. A member data model supportingunlimited member indicators will support IME to track members with additional characteristics.9.1.1.1 | 25
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Part 4 - Iowa Medicaid Enterprise

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