Part 4 - Iowa Medicaid Enterprise

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RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsAll rates have specific effective start- and end-date spans. eCAMS is able to select the correct rate toapply based on the type of rate needed and the date of service of the related claim.Figure 9.1.2.1-50. Rate Setting Options Available in eCAMS. eCAMS offers a wide variety of methods tosupport rate setting activity.PR2.07.01In eCAMS, Provider rate segments are maintained in the Rate Setting business process area, and onlyauthorized users are allowed to make any changes. Rate segments are date driven, and each segment has astart date, end date, and effective date. As shown in Figure 9.1.2.1-51 and Figure 9.1.2.1-52, eCAMSmaintains the rate segment. Each from- and to-date can have a different value. Figure 9.1.2.1-53 showsthe history/audit trail of the changes to the rate segment.Figure 9.1.2.1-51. Rates List. eCAMS rate list shows different rates stored in the database. Search andfilter capabilities allow the user to quickly find the rate they are interested in viewing.9.1.2.1 | 66
RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.2.1-52. View Rate Details. By selecting a rate from the list page shown in the precedinggraphic in this series the user can view the specific details for that rate.Figure 9.1.2.1-53. Rate Setting History. eCAMS shows the complete history of the rate including theapproval date, effective data span, and before and after values.PR2.SS.01eCAMS maintains coverage and restriction information through benefit plans and programs and supportsfactors such as procedure, revenue, diagnosis, surgical, modifiers, place of service, provider type,taxonomy, claim type, bill type, and recipient aid category to define service coverage and restrictions.Service limitations are defined and maintained through online screens, as identified in Figure 9.1.2.1-54.9.1.2.1 | 67
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Part 4 - Iowa Medicaid Enterprise

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