Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsBE1.SS.02eCAMS supports the ability to trigger automated processes such as correspondence generation, alerts,and notification based on system events or user-initiated actions. For example, eCAMS can be configuredto generate an alert based on receipt of a claim containing a procedure code related to birth or terminationof pregnancy.Figure 9.1.1.1-23 depicts different alert messages available in user inbox based on user triggered orsystem triggered events.Figure 9.1.1.1-23. Alert Messages. eCAMS provides different alert messages based on whether thetrigger event is from the system or the user.BE1.SS.03eCAMS receives and stores eligibility segments from one or multiple source systems. Each segmentcontains start and end dates, as well as the transaction date, which indicates the date the record was postedto eCAMS.If an incoming record conflicts with an existing record, Department defined business rules are applied toconfigure eCAMS to produce the most effective resolution. Example resolutions are:• Reject the incoming record whenever it conflicts with an existing record. Report the rejected record tothe source system.• Replace the existing record by flagging it as inactive, resulting in a "soft-delete" of the existingrecord. The existing record is no longer available to any eligibility, benefit plan, claim or PA process;and is only visible to users authorized to view inactive records. The new incoming record replaces theexisting record. Benefit plans are updated accordingly.• Adjust the existing record to end one day before the start of the new record. Keep both records activeand treat the new record as a change in eligibility.eCAMS maintains current and historic eligibility information for claims adjudication and eligibility inquirywith eligibility begin, end dates, and other eligibility factors received from the interface file. Based on dateof service, the member eligibility record will be applied during claims and encounter processing.9.1.1.1 | 31