MMIS Vendor Information

• a vendor to provide MMIS Design, Development, Implementation (DDI)
  and Operations and Maintenance services,

• a vendor to provide Quality Assurance (QA) services.

Design, Development, Implementation (DDI) and Operations and Maintenance services

DHS has procured a DDI Contractor to perform a specific set of activities to support the development, implementation, operations and maintenance phases of the MMIS Replacement Project. The procurement called for the Contractor:

• to propose a base MMIS that is currently in production in another state and to propose the hardware, software, and services required to modify and enhance the base MMIS to meet Oregon‘s functional and technical requirements.

• to recommend the MMIS best practices and workflow procedures to support DHS’ continued operation of Medicaid claims processing and administration of the Medicaid Program and to assist DHS in organizational and cultural changes needed to support implementing the new MMIS.

• to work with Oregon's Medicaid providers to implement HIPAA requirements for the National Provider Identifier (NPI), also known as the Standard Unique Health Identifier for Health Care Providers, which were published in the Federal Register, 45 CFR Part 162, dated Friday, Jan. 23, 2004.

• to prepare the MMIS for federal certification and to conduct planning activities to assure the new MMIS is developed and enhanced to meet the Medicaid Information Technology Architecture (MITA).

• to provide the services to operate, maintain and enhance the MMIS systems for an 8 year period (5 base years and 3 optional years) to meet the operations requirements.

• to provide Medicaid Pharmacy Benefit Management services to support drug claims processing, utilization management, the drug rebate program, pharmacy expertise and help desk and needed auditing services.

• to provide other services as defined in work orders to support Medicaid and non-Medicaid needs.

The scope of the MMIS requirements includes the following major functionality/subsystems:

• Electronic Document Management System (EDMS) to support the workflow and scanning of Medicaid paper claims and other documents;

• Pharmacy Point of Sale (POS) and Pharmacy Benefit Management (PBM) functionality to support the pharmacy claims processing requirements;

• Decision Support Surveillance and Utilization Review System (DSSURS) and supporting Data Warehouse. The Decision Support (DS) System provides access to and manipulation of data from the MMIS for the purpose of data analysis and reporting. SURS is a subsystem of the MMIS that assists in the assessment of the level and quality of care provided to medical assistance beneficiaries, produces statistical profiles of the health care delivery and utilization patterns, and facilitates the investigation of suspected instances of fraud and abuse by program participants;

• Telephony eligibility verification system to allow providers to access client eligibility through the telephone;

• Web based services for eligibility verification and enrollment, member services, benefits administration, service authorization, provider enrollment, contracts management, claims and encounters submission and processing, financial services, federal reporting, and quality assurance and utilization management.

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Quality Assurance (QA) services

DHS has procured a Quality Assurance (QA) Contractor to assure that the Design, Development, and Implementation Contractor (DDI Contractor) applies best practices in project management, and delivers technical work products that meet DHS requirements in respect to schedule, cost, functionality, reliability, security and other quality standards. The QA Contractor shall perform five (5) primary tasks:

1. Quality Management (QM)
2. Quality Assurance (QA)
3. Quality Control (QC)
4. Independent Verification and Validation (IV&V)
5. Risk Assessment (RA)

The DHS Contract Specialist for these procurements is Ms. Suzanne Fuher, 503-378-2101, ext. 366.

DHS News Release, July 11, 2005