Q.

What is an MMIS?

A.

The Medicaid Management Information System (MMIS) is the mechanized claims processing and information retrieval system that all states are required to have according to section 1903(a)(3) of the Social Security Act and defined in regulation at 42 CFR 433.111. All states operate an MMIS to support Medicaid business functions and maintain information in such areas as provider enrollment; client eligibility, including third party liability; benefit package maintenance; managed care enrollment; claims processing; and prior authorization.

Q.

What are the ways that providers can bill in the MMIS?

A.

They can bill using the Provider Web Portal, paper claim submission, or by using Electronic Data Interchange (EDI). By March 2009, providers will be able to use the Provider Web Portal for individual claim submissions (one submission at a time); EDI is the electronic exchange of claimed data from the billing provider to other health care payers, including DHS, in a HIPAA-compliant batch format. You can learn more about EDI on the DHS EDI Web site.

Q.

How many diagnosis codes can be entered for each claim type?

A.

The maximum number of diagnosis codes the new system allows for each claim type are as follows:

• Dental claims: 6 codes
• Pharmacy: 9 codes
• Professional: 8 codes
• Institutional: 26 codes

Q.

Can you tell me where the PIN letter for my office will be mailed to?

A.

The PIN letters will go to the mailing address on file for each provider. If you have multiple locations or providers to bill for and want to know which location your PIN letters will go to, contact DMAP Provider Enrollment (800-422-5047).
 
If you need to update your mailing address so that you can receive your PIN letters at the right address, make sure to complete and submit the Provider Information Update (DMAP 3035) form to DMAP Provider Enrollment.

Q.

What happens if I lose or misplace my PIN letters?

A.

You will need to contact DMAP Provider Services (800-336-6016) with your DHS provider number so that they can send a new PIN letter to you by U.S. mail. It will take 3-5 business days to arrive. Make sure to keep your PIN letters safe so that you are able to verify eligibility when the replacement MMIS goes live!

Q.

What are the system requirements to use the Provider Web Portal?

A.

To use the Provider Web Portal, you will need a compatible browser and an internet connection. If you have support staff who do not have internet access and you want them to perform certain functions of the Web portal, make sure you get them appropriate access.

Q.

Does the Web portal display the primary care provider (PCP)'s information?

A.

The Web portal only displays a client's Primary Care Manager (PCM). To obtain information about a client's PCP, you would continue to contact the client's OHP managed care plan.

Q.

I anticipate having over 200 employees in the role of Eligibility Inquiry; all will need to contact DHS for password resets. What is the best way to do this? Are there any other options than requesting resets by phone?

A.

To avoid password resets, you need to make sure that employees know to not do more than two (2) failed logins attempts.

• After the second failed login, don't try a third time. Instead, go straight to the reset password screen of the Web portal and reset your password by answering one of your secret questions.
• For more information, refer to section 8.5 of the Web Portal Handbook on MMIS Course Information page.

Q.

Can I use a Mac instead of a PC to access the Web portal?

A.

The Provider Web Portal supports Mozilla Firefox 2 on PCs, but at this time, DHS does not know whether the Provider Web Portal supports Mozilla Firefox 2 on Macs. Ensuring Web portal support of Macs is planned as a future enhancement.

Q.

How often do Web portal passwords expire?

A.

They expire every 90 days.

Q.

If the Web portal maintains 6 years of claims data, do I still need to keep my own claims on file for auditing purposes?

A.

The availability of historical claims data on the Web portal does not replace your office's recordkeeping requirements, or any existing state and federal rules for keeping necessary claims documentation on file.

Q.

We are a facility with individual practitioners working for us. Will our practitioners have Web portal access?

A.

Your individual providers may get PIN letters if they have their own state Medicaid ID. This will be in addition to the PIN letter your group/clinic gets.

• If your individual providers have separate Web portal access, anything they submit will be tied to their Medicaid ID number, not the facility's.
• If everything done at your company needs to be tied to the group/clinic's ID, you may decide not to set up Web portal accounts for your individual providers. You might opt to set up your primary account, and all clerk accounts, underneath the clinic/group's ID using the corresponding PIN letter.
• Then, when you submit something such as a claim or PA that must be tied to a specific provider, you can enter the provider's NPI in the rendering/servicing provider ID field on the Web portal.

Q.

When using the "search" links on the web portal to locate codes and other values, will the Web portal return results that start with the search criteria I entered or results that contain the search criteria I entered?

A.

The search links on the Web portal return results that start with the search criteria you entered. For example, searching for the word "viral" will return all results that start with the word "viral." It will not return all possible results containing the word "viral."

Q.

Is the Web portal secure? How will providers get access to the Web portal?

A.

Yes, it is secure. The Provider Web Portal is available only to enrolled providers that DHS has authorized to use the portal. Users must have a secure username and password to access the portal.

DHS will send authorized providers an initial logon ID and PIN via U.S. ground mail. Providers will then need to login and select a unique username and password in order to start using the Provider Web Portal.

Q.

Can providers see a demonstration of the Web portal?

A.

You can access the MMIS Provider eCourse to get hands-on experience using the Web portal. Learn how to access the eCourse at this link.

Q.

How far back will providers be able to access historical claims on the Web portal?

A.

All claims on file in the MMIS will be available to providers. Initially, this will include six years of converted historical claims (plus all lifetime procedure claims), and will eventually grow to include 10 years of historical claims.

Q.

We are a billing agency that bills for many providers. Can we get one Web Portal ID set up for us to access all of our providers' information?

A.

Providers will receive a DHS ID and PIN letter to allow them access to the secured Web Portal. Once the acting administrator of that office assigns you as a clerk, you will be defined as a supporting staff member that will need system access to work on behalf of the provider. A clerk can be assigned to more than one provider.

Q.

Does the Web Portal replace my current eligibility verification system?

A.

The Provider Web Portal only replaces Web-based AIS. Both Web and telephone AIS services will end when the new system goes live.

If you do not use AIS to verify eligibility, then you need to contact your vendor to find out if they will continue to provide eligibility verification services in the new system.

Q.

What if the Third-Party Liability (TPL) panel shows different resource information than what we have? Who would we notify?

A.

Report the resource to DHS using the DHS 8708 (Insurance Notification Form).

Q.

Will the Provider Web Portal show who the client's primary Medicare carrier is?

A.

If the information is available to DHS, the client's Medicare carrier information will display in the Third Party Liability (TPL) panel of the Eligibility inquiry response.

Q.

Does the Medicare Paid Amount field on Web portal claims allow negative dollar amounts?

A.

No. The paid amount must be greater than or equal to zero.

Q.

Will the Provider Web Portal allow us to search for more than a one-month eligibility time span?

A.

The Web portal allows you to view up to 13 months of historical eligibility data (through the date of inquiry). As in the current system, you can't request eligibility verification for future dates.

Q.

We are a billing service and bill for many different providers that are not associated with each other at all. How can I get access to the Web portal for each of these providers?

A.

You will need to contact each of your customers and ask them to give you access to their Web portal accounts.
 
One of your customers will have to create a Web portal account for you so that you are in the Web portal system. Once that account is created, you can communicate the information for your account to your other customers so that they can search for you and add you as a clerk on their own Web portal accounts.