Medicaid Management Information System MMIS Replacement

1
Medicaid Management Information System (MMIS)
Replacement

• Design, Development and Implementation Phase

2
System Requirements

• Federally Certified MMIS by CMS
• Fully HIPAA compliant
• National Provider Identification
• Claims Attachment
• Transaction Modifications
• On-line, real-time adjudication and inquiry
  capabilities
• MMIS must be a modular and flexible system
• Web based services
• On-line provider enrollment, eligibility
  verification and enrollment, member services,
  benefits administration, service authorization,
  provider enrollment, claims submission and
  processing and utilization management

3
Design Phase

• Subject 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 policy
• Review of system test plan, system test results

4
Business Needs for Replacing MMIS

• Old Technology, implemented in 1978
• Current MMIS does not provide sufficient
  technology and innovation to further automate and
  support DHSs business processes
• Problems with data integrity
• Changes in legislative enactments, new
  technology, new programs, new methodologies all
  require a timely enhancements or changes of the
  MMIS

5
Business Needs for Replacing MMIS

• Difficult to staff and maintain legacy technology
• Difficult to perform user ad-hoc reporting
• Lack of flexibility - business rules embedded in
  code, scattered throughout the code
• MMIS must support a variety of benefit programs
• The need to adapt and implement future compliancy
  issues that are required under the federal Health
  Insurance Portability and Accountability Act
  (HIPAA).

6
Business Process Improvements

• On-line submission, adjudication, and inquiry of
  claims, prior authorizations, and provider
  enrollment information
• Improved accuracy and timeliness of claims
  processing
• Flexible, modularly designed system that is
  user-friendly, easy to maintain, and easy to
  enhance
• Handle specialized program components within
  Medicaid and State CHIP programs, as well as
  other State health care programs

7
Business Process Improvements

• Workflow systems streamline the claims processing
  functions and improve the efficiency of claims
  operations
• Internet access and portals will greatly enhance
  selective access of external stakeholders
• Automated review of claims and codes, rather than
  current manual processes
• Faster, more accessible, and accurate reports
  through the DSS system Support

8
Business Process Improvements

• Integrated telephone answering with claims system
• Document Management component to facilitate the
  consistency of forms submitted and scanned.
• Improved Internal Controls (dupe payments, etc)
• Support new and changing claims payment
  methodologies
• Ability to communicate rule changes and current
  rules with stakeholders
• Reduction in development costs

9
Replacement Options

• We are considering several options, which Fox
  Systems, Inc. will be detailing in their final
  Cost/Benefit Analysis
• The 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.