Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS Operationsreason for the addition of the indicator, along with the user ID and date of addition. Figure 9.1.2.1-46shows an example of a newly approved indicator along with the history showing the reason for thechange. The new indicator is then immediately available to eCAMS Claims adjudication in real-timeFigure 9.1.2.1-46. Approved New Indicators with History. During the approval process, eCAMS capturesthe reason for the change, the date and time of the change and the effective start- and end-date for thechange. Using eCAMS View History function, authorized users can view the history.PR2.03The Operations Management business process areas and Care Management business process areas useeCAMS integrated provider data to perform their activities. Claims will not be paid if the provider datafails to support the provider’s eligibility to perform or deliver the claimed services. Prior authorizationswill not be allowed if the provider is not eligible to perform or deliver the planned service. The ongoingvalidation of eligibility is managed through edits that check the eligibility of the provider on the date ofservice of the claim for the service specified.PR2.04The eCAMS Provider Management business process area interfaces with the Online Survey Certificationand Reporting (OSCAR) data base to validate CLIA certification levels. The CLIA certification level isstored on the provider's database record and is used in claims adjudication to ensure payment only forthose specific procedures that the laboratory is authorized to perform.PR2.04.01The eCAMS Provider Management business process area interfaces with the Online Survey Certificationand Reporting (OSCAR) data base to validate CLIA numbers during enrollment and for subsequentmaintenance activities. CLIA certification number and status are a permanent part of the provider's record9.1.2.1 | 62