Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.1.1-18. LTC Eligibility Information. eCAMS stores LTC eligibility information forclaims processing.BE1.09.03eCAMS supports a wide range of pricing rules, including code specific rates, provider specific rates,recipient rates, group rates, and taxonomy rates. All of these rates are contained on the rate setting tableswhich are viewable online by authorized users. Rates are maintained either manually or uploaded intoeCAMS and applied in a batch environment. eCAMS provides the flexibility to configure the providermanagement business area to maintain provider and rate-specific data in support of applicablecertification criteria.BE1.10eCAMS provides the capability to maintain audit trail in the member business process area. eCAMS willhold requests from members for personal records and will document related case activities through theeCAMS case management business process area. The activity list will track the request date, source,status, and other details along with the communication details.BE1.11The eCAMS data model maintains comprehensive data elements for audit trails for data additions andupdates of member eligibility records processed via interface for batch eligibility files, real-timeeligibility updates or direct data entry (DDE) screen updates from authorized users in eCAMS. The datamodel includes fields such as source/created by, modified by, created time, modified time, start date, andend date.The system maintains an indicator of the source system as part of the eligibility, demographic, and benefitplans information.eCAMS generates error reports for the daily eligibility files, loaded via interface, and control reportsshowing the number of records which were successfully created in the system, error records, and updatedrecords for the member data received from multiple eligibility sources.9.1.1.1 | 27