Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsBE2.SS.09eCAMS maintains lock-in information in its member data repository and supports physician, househospital, and pharmacy lock-in indicators. Figure 9.1.1.1-45 depicts member lock-in for a provider.Figure 9.1.1.1-45. Member Lock-in. eCAMS list page showing provider lock-in assignments for amember.BE2.SS.08eCAMS maintains eligibility, benefit plan, cost of sharing, provider lock-in, TPL, Medicare eligibility,and EPSDT information as part of member information. This information is accessed by claimsadjudication, payment, managed care, and TPL recovery processes.eCAMS provides the flexibility to configure reports showing the number of members in lock-in status,the reason for the lock-in and the number of unauthorized providers billing for services during lock-intime segments.BE3.01eCAMS allows authorized users to inquire member eligibility information by providing primary attributesfor the date of service so it will display the eligibility details. The system has the capability to track theuser inquiry details including inquiry date and time, inquiring provider or eCAMS ID, date(s) of service,and member ID. Figure 9.1.1.1-46 depicts providers submitting member eligibility inquires for date ofservice using eCAMS screen functionality.9.1.1.1 | 50