Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.2.1-74. eCAMS Finance Payment Hold Detail. The eCAMS Payment Hold Detail screenallows users to hold provider payments.eCAMS provides authorized users with the functionality to setup up payment withholds at the providerlevel. Payment withholds can be based on either a fixed amount or percentage. Based on the withholdsetup, appropriate amounts are withheld from the provider payments of adjudicated claims in eachpayment cycle. After completing the settlement process with the provider, authorized users can release orend-date the withhold condition which then releases. Once the withhold condition is released or end-datedall withheld amounts are released for payment to the provider.PR3.SS.05eCAMS identifies pending disenrollment actions for providers under the following circumstances:• Any required credential expires• 100% match on provider information with the SSA Death Registry including Name, TIN, andfull address• 100% match on provider information with the OIG LEIE sanction file including Name, TIN, andfull addressWhen any of these conditions are detected as a result of interface processing or nightly credential review,eCAMS generates a notification to Provider Services. eCAMS supports automatic disenrollment based onall three of these conditions.PR3.SS.06eCAMS provider database supports the data structures required to identify providers who are usingelectronic health records including their certification numbers from the EHR system.9.1.2.1 | 86