Presentation on theme: "Medicaid Management Information System (MMIS) Replacement"— Presentation transcript:
1Medicaid Management Information System (MMIS) Replacement Design, Development and Implementation Phase
2System Requirements Federally Certified MMIS by CMS Fully HIPAA compliantNational Provider IdentificationClaims AttachmentTransaction ModificationsOn-line, real-time adjudication and inquiry capabilitiesMMIS must be a modular and flexible systemWeb based servicesOn-line provider enrollment, eligibility verification and enrollment, member services, benefits administration, service authorization, provider enrollment, claims submission and processing and utilization management
3Design PhaseSubject Matter Experts will meet with contractor staff to refine and finalize all system and business process requirements.Each subsystem will contain staff from both the IT and business side to ensure system requirements are met and business processes are evaluated and improved with each program area.Verify that system business rules are synchronized with business policyReview of system test plan, system test results
4Business Needs for Replacing MMIS Old Technology, implemented in 1978Current MMIS does not provide sufficient technology and innovation to further automate and support DHS’s business processesProblems with data integrityChanges in legislative enactments, new technology, new programs, new methodologies all require a timely enhancements or changes of the MMIS
5Business Needs for Replacing MMIS Difficult to staff and maintain legacy technologyDifficult to perform user ad-hoc reportingLack of flexibility - business rules embedded in code, scattered throughout the codeMMIS must support a variety of benefit programsThe need to adapt and implement future compliancy issues that are required under the federal Health Insurance Portability and Accountability Act (HIPAA).
6Business Process Improvements On-line submission, adjudication, and inquiry of claims, prior authorizations, and provider enrollment informationImproved accuracy and timeliness of claims processingFlexible, modularly designed system that is user-friendly, easy to maintain, and easy to enhanceHandle specialized program components within Medicaid and State CHIP programs, as well as other State health care programs
7Business Process Improvements Workflow systems streamline the claims processing functions and improve the efficiency of claims operationsInternet access and portals will greatly enhance selective access of external stakeholdersAutomated review of claims and codes, rather than current manual processesFaster, more accessible, and accurate reports through the DSS system Support
8Business Process Improvements Integrated telephone answering with claims systemDocument Management component to facilitate the consistency of forms submitted and scanned.Improved Internal Controls (dupe payments, etc)Support new and changing claims payment methodologiesAbility to communicate rule changes and current rules with stakeholdersReduction in development costs
9Replacement OptionsWe are considering several options, which Fox Systems, Inc. will be detailing in their final Cost/Benefit AnalysisThe options range from “turn-key” operations to outsourcing various business functions.The RFP will likely contain several options for the vendors to consider, with a preference issued by the state.