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 9.1.2.1-23. Provider Termination by Medicaid Authority. eCAMS can be used to terminate aprovider as of a specific Start Date. The Business Status value and the Reason for Business StatusChange value provide details on the termination. On saving the change, the new business status isimmediately effective in real-time.Figure 9.1.2.1-24 shows that the termination action has been applied. eCAMS claims adjudication processrecognizes and applies this status change immediately in real-time.Figure 9.1.2.1-24. Provider Termination by Medicaid Authority. IME can apply the MedicaidAuthority termination status using eCAMS to change the provider’s active status to “terminated” on the6/29/10 “Start Date.” The eCAMS adjudication process would deny any claims the provider submitted onor after 6/29/2010.Authorized users may reactivate (manually release) a previously terminated provider. The authorized userfollows the same process to release the provider by manually changing the provider's business status to"Active." eCAMS requires the authorized user to enter the effective start- and end-date for the provider'sreactivation, a reason for the action, and an optional narrative text description of the action taken. Themanual release process must be applied to the provider's overall business status and the business status ofthe provider's location(s) in order for the provider to submit claims successfully. eCAMS will check thedate of service on the claim against the provider's status to determine if the claim should be paid ordenied. Additional controls can be applied to set the newly reactivated provider's claims to suspend for9.1.2.1 | 40
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operationsmanual review before paying. Please refer to Team Noridian's response in section 9.1.2.1.2, RequirementPR2.02.01, for additional details on the process used to trigger pre- and post payment manual reviews.PR1.02.06eCAMS fully supports the required ability to suspend a provider application in a pending status. eCAMSinteractive online enrollment application provides structured, online screens with wizards that guide theprovider step-by-step through the eCAMS enrollment process. The provider may begin an application andedit while working on it during multiple sessions over several days or weeks depending on theDepartment's policy. Until the application is submitted, it remains in a suspended state. The eCAMSwizard maintains the completion state of the application and allows the provider to continue exactlywhere they left off.When the provider completes the application, the provider submits the application to IME for review anddecision. The IME provider enrollment specialist may begin reviewing the application. Like the provider,the enrollment specialist can work on the application during multiple sessions over several days or weeks.Until an approval or denial decision is reached. During the review period, the enrollment specialist cansuspend the application while the provider responds to a request for additional information. eCAMSmaintains the application in a suspended state until all review processes have been completed and theenrollment specialist records the approval or rejection decision.PR1.02.07eCAMS assigns a unique tracking number to each provider enrollment application. eCAMS assigns thetracking number as soon as the provider submits basic identification credentials, including their TIN andNPI if applicable. The unique tracking number remains with the application throughout the enrollmentand application review processes. Figure 9.1.2.1-25 shows the basic information capture screen.Figure 9.1.2.1-25. eCAMS Basic Information Screen. The eCAMS basic information screen capturesessential information about the enrolling provider.9.1.2.1 | 41
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Part 4 - Iowa Medicaid Enterprise

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