Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.1.1-40. Creating Different Limitations. Users can define different service coverage orLimitations which will be used by claims.BE2.04The eCAMS benefit plan definition maintains service coverage and service limits restrictions, and usesapproximately 18 factors, including procedure code, revenue code, place-of-service code, taxonomy, billtype, and geographic location. The service limitations include both dollar-based and unit-based limits.Benefit plan information includes cost sharing information such as plan premiums, deductible,spenddown, and co-pay.BE2.05The eCAMS Benefit Plan definition covers cost sharing information, including premiums, co-pay,deductible, and spenddowns. eCAMS can also define cost-sharing frequency.Figure 9.1.1.1-41 illustrates options for defining cost-sharing tiers. Options include such values as the tierbasis, (income or family size), tier start and end dates, family size and income, premium paymentfrequency and amount, co-pay frequency and amount, out-of-pocket ceiling frequency and amount, andspenddown frequency and amount.9.1.1.1 | 46