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 9.1.1.1-49. Protected Population Indicator. An easy-to-use protected-population indicator isnative to eCAMS for audit, privacy, and security needs.BE5.01As described in our response to requirement BE5.06, eCAMS implements a bi directional buy-in dataexchange process for maintaining up to date information on the Medicare buy-in status of members.eCAMS has the capability to determine eligible buy-in members based on based on CMS or State definedcriteria. eCAMS Medicare Buy-In Maintenance screens allow the user to track the Buy-In Recipient Listand Buy-In status along with the payment made. The interface instances screen provides informationrelated to the statistics tied to the number of records processed, records in error, error description, andcorrection messages.Figure 9.1.1.1-50 shows the Interface screen that will be used as part of the support of Department Buy-Inbusiness requirements.Figure 9.1.1.1-50. eCAMS Support for Buy-In Interfaces. Flexible eCAMS interface definitions supportbuy-in interfaces to support Department cost-containment efforts.9.1.1.1 | 54
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsWe understand the critical role this information plays in ensuring accurate claims processing. TheeCAMS system provides the capability to be extended to support premium reimbursements for additionalDepartment programs.BE5.02The eCAMS outbound interface transmits potential Medicare Buy-In member information to CMS forverification and matching. After Medicare has performed verification and matching, automated premiumsare established and paid on behalf of the member.BE5.03eCAMS receives buy-in member information via the interface and applies records into the system. Thesystem will track the number of records applied into the system, and the error out records will be reportedin email notification. The eCAMS EXACT interface framework processes CMS Buy-In responses andautomated premiums are established and paid on behalf of the members.BE5.04eCAMS processes change transactions and updates member Buy-In information in an automated fashion.eCAMS online screens help track Buy-In members and premium history information. The system willtrack errors or discrepancies during file processing using interface so that the system can report them inemail notification to correct the data for reprocessing.BE5.05eCAMS Medicare Buy-In Maintenance screens allow the user to track the Buy-In Member List andBuy-In status along with the payment made. The interface instances screen provides information relatedto the statistics tied to the number of records processed, records in error, error description, andcorrection messages.BE5.06The eCAMS member business process area allows the user to track the Buy-In Member List and Buy-Instatus along with the payments made. The buy-in payment history screen displays members eligible butpremiums have not been paid.BE5.SS.01eCAMS receives buy-in Medicare details from CMS and processes the details via interface. All buy-indetails are stored in the system and the system will set an indicator for all buy-in transaction membersbased on their eligibility status. Based on Department defined schedules, the system can generate alerts tomembers for their eligibility or cost sharing status change.BE5.SS.02eCAMS supports a bi directional Medicare buy-in data exchange process with CMS. Automatedpremiums are established and paid on behalf of the members. eCAMS automatically processes changetransactions and updates member buy-in information. eCAMS online screens help track Buy-In membersand premium history information.BE5.SS.03eCAMS combines the ability to track dual Medicaid/Medicare eligibles, along with death information,to identify the Medicare buy-in members to report to CMS for the purpose of deleting their buy-instatus. eCAMS will use evidence of an end in Medicare or Medicaid coverage, or evidence of the deathof a member, to include the member's record in the outbound CMS interface for termination of theirbuy-in program.9.1.1.1 | 55
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Part 4 - Iowa Medicaid Enterprise

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