Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.2.1-72. Reactivate Inactive Provider. In this example, the provider requests reactivation as ofJuly 27, 2011. The request has been applied and both the Provider and the providers NPI base locationhave been reactivated. The inactive time span is also captured as a part of the status history.PR3.SS.03eCAMS will retain a minimum of five years of provider demographic information, rates, and claimpayment history for online inquiry by the contractor and authorized IME staff. Data retention willconform to IME specification. All information stored in the eCAMS database includes the effective datespan which specifies both the start- and end-date for the related data.PR3.SS.04eCAMS supports this requirement by provider hold and provider withhold indicators on the provider file.The hold can be placed at the provider level or at the invoice level. Whenever a hold is placed at theprovider level, the provider is not included in the payment file. Figure 9.1.2.1-73 shows a Provider HoldReview Indicator that is awaiting approval.Figure 9.1.2.1-73. Provider Hold Review Indicator. After approving the Provider Hold Review Indicator,the Claims business area will cause any claims to suspend with a Hold Review edit.Whenever a hold is placed at the invoice level, only the invoice which is on hold is not included in thepayment file. eCAMS provides functionality to hold the provider payments along with a workflow forprocess that notifies the supervisor about the hold that is placed. The supervisor can either approve or rejectthe hold. Figure 9.1.2.1-74 shows the Payment Hold Detail page, which allows the user to place paymentson hold and identify the reason and expiration time for the hold, if the approval is not completed.9.1.2.1 | 85