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 providers will use the replacement MMIS at implementation?

A.

All providers who bill Oregon Medicaid for payment using the CMS-1500, UB-04, ADA 2006, DMAP 505, DMAP 1036 paper claims or using Electronic Date Interchange (EDI) will use the replacement system.

Q.

Why are we replacing the current MMIS?

A.

The DHS MMIS contains 30-year-old technology that is extremely out-of-date, and in need of replacement. The system cannot handle the state’s current needs of processing payments to approximately 31,000 health care providers and tracking the medical eligibility of about 600,000 Oregonians.

Our current system was designed to handle about 260,000 claims per month; it is now processing over 2 million claims monthly. Because the system is so overworked, it has become difficult to maintain and is incapable of being expanded to meet future needs.

Q.

What makes the replacement MMIS better than the current MMIS?

A.

Providers get many benefits from the replacement MMIS (listed here).

The replacement MMIS is based on a CMS-certified model that is currently operating in several other states. It uses current technology that will allow DHS staff to easily access, update, and analyze data. It will also allow DHS to update the MMIS to keep pace with changes in claims volume, program/policy, technology, and more.  

Q.

Who is helping DHS replace the MMIS?

A.

DHS is using the services from Electronic Data Systems (EDS). It was determined that the most cost-effective solution for Oregon’s Medicaid operation would be to have the system put in place by a company that has a proven track record in successfully designing and implementing Medicaid Management Information Systems in other states.

Q.

I have questions about how the replacement MMIS will work for me. Who can I talk to about my concerns?

A.

If you have any specific questions you’d like to ask, you can always e-mail us at mmis.questions@state.or.us. We will review your question and answer it on this page, or refer it to your appropriate DHS division contact for follow-up.

Q.

Am I already using the MMIS?

A.

If you submit claims to DMAP today, your claims are being processed through the MMIS today.

Q.

What are the ways that providers can bill with the replacement MMIS?

A.

They can bill using the Provider Web Portal, paper claim submission, or by using Electronic Data Interchange (EDI). The Provider Web Portal supports individual claim submissions (one submission at a time); EDI is the electronic exchange of claimd 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.

Will the new system be faster?

A.

Like today, the replacement MMIS will adjudicate claims according to a fixed weekly payment cycle.  But in the replacement MMIS, providers will be able to submit claims directly into the MMIS via the Provider Web Portal. Like EDI claims, Web Portal claims bypass the steps required for paper claims processing, which allows for faster entry of claims into the MMIS.

Another timesaver is that you will no longer need to wait for your paper Remittance Advice to arrive in order to find out the status of your submitted claims. If you submit a claim via the Provider Web Portal, you will see at the time you submit the claim whether it will pay, deny, or suspend.

You will be able to check the Provider Web Portal for any claim you have submitted (Web, EDI, or paper), and find out its adjudication status before your RA arrives. If needed, you will also be able to make adjustments to suspended or denied claims you review online.

Q.

We aren’t able to do electronic billing in the current system. Will we be able to do this in the new system?

A.

There will be three ways a provider will be able to submit claims. By paper, electronically, or through the MMIS Provider Web Portal

If you have questions about Electronic Data Interchange, contact DHS EDI Support Services at dhs.edisupport@state.or.us. For information about how to register and test to become an EDI Trading Partner so that you can submit EDI claims to DHS, go to the EDI Registration and Testing page.

Q.

We aren’t able to do electronic billing in the current system. Will we be able to do this in the new system?

A.

Yes. If you only bill a few claims a month, submitting claims on the Web may be for you. The statewide trainings walk through the process of submitting claims using the Provider Web Portal.

Q.

We currently submit claims through a clearinghouse/billing service/vendor. Will be we able to continue using them in the new system?

A.

DHS will test all current EDI Trading Partners to make sure their EDI transactions (including claims) process correctly in the new system.

If your EDI submitter is able to set up the transactions as outlined in the new MMIS Companion Guides, connects successfully with the new MMIS EDI server, and tests successfully with DHS, you should be able to continue using your current submitter.

Q.

We are a skilled nursing facility. We do not currently bill DHS using the UB-04 or CMS-1500. Does the September 2008 deadline apply to us?

A.

In September, all nursing facilities will be required to use the standard institutional claim format (UB-04 paper form or 837I transaction) to receive Medicaid payment.

If you have never billed on the UB-04 and want to register for training, e-mail mmis.questions@state.or.us, and we will forward your e-mail to SPD’s MMIS training coordinator.

If you would like to register to bill DHS using the 837I transaction, e-mail dhs.edisupport@state.or.us for more information.

Q.

What happens if a provider needs to adjust a claim that is older than one year? Will we be able to adjust that claim on the Web?

A.

Yes. The new system does not enforce timely filing limitations on claim adjustments. Providers can adjust any claim in the MMIS, regardless of the submission date.

However, the timely filing of submitting claims is still enforced.

Q.

Is the Medical Care ID changing?

A.

Yes. The monthly letter-sized Medical Care ID will be replaced with a one-time wallet-sized Medical Care ID card for each client eligible for DHS medical assistance. DHS will only replace a client's card upon request, or if the client's name changes.

The new Medical Care ID will only show the client's name, Medicaid ID number, and the card's date of issue.

Q.

How does this change affect me?

A.

The Medical Care ID itself will no longer be considered proof of eligibility. Providers will need to verify client eligibility, obtain third-party resources and enrollment information using one of the methods described at this link.

Q.

Will the new Medical Care ID be a magnetic stripe card ("swipe card")?

A.

No. Like the cards of some private health insurance carriers, the new ID will be paper.

Q.

Can I see a sample of what the new Medical ID card will look like?

A.

A sample is available here. (PDF)

Q.

How will provider enrollment change?

A.

In the replacement MMIS, providers will be able to submit most of their basic enrollment over the Web (learn more at this link). Required attachments will be mailed or faxed to a secure, central location for scanning and entry into the MMIS.

The system also supports interfaces with Oregon’s Board of Medical Examiners, Board of Nursing, and Board of Pharmacy that will allow DHS staff to more quickly validate any licensing credentials required for provider enrollment.

Q.

As an enrolled provider, will I need to change how I submit information updates to DHS provider enrollment staff?

A.

Many providers will be able to update contact information, address information, office hours and more via the Provider Web Portal (learn more at this link).

Q.

When will DHS implement the replacement system?

A.

The replacement MMIS is set to "go live" later this year. The features described on the How you will benefit page, including the Provider Web Portal, will not be available until this date. For information on what you can do now to prepare for implementation, go to the What you can do now page of this site.

Q.

What do I need to do to get ready to use the new system?

A.

Review the changes listed on the What you can do now page. This page lists the various changes that will come with the replacement MMIS and what you can do now to prepare.

Q.

How is DHS helping providers get ready for the replacement MMIS?

A.

DHS has formed the Provider Implementation Workgroup to make sure appropriate communications and training allow providers to learn what they need to do to get ready for the replacement MMIS. You can learn more about the mission and goals of this workgroup on the About Us page of this site.

Q.

Will my existing direct deposit information be converted to the replacement MMIS?

A.

Yes. DHS and EDS are reviewing all provider information stored in the current system and establishing how to convert this information into the replacement system.

Q.

What are the system requirements to use the replacement MMIS?

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.

What will providers be able to do using the Web portal?

A.

There are many benefits to using the Provider Web Portal, and you can read about them at this link. One significant benefit is that providers will be able to submit claims, prior authorization requests, and eligibility inquiries, then get immediate response about the status of those requests, including current information about third-party resources (TPR) and managed care enrollment in client eligibility verifications – all online.

Q.

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

A.

Yes, it is secure. The Provider Web Portal provides all the benefits listed at this link, and 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.

Prior to the implementation date, 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.

Providers who attend one of the Oregon MMIS Implementation training sessions in 2008 will be able to see a demonstration of the Provider Web Portal, and also take home information about how to use the Web portal once the replacement MMIS goes live. Go to the MMIS training information page to learn more about plans for provider training.

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 already use Web-based eligibility verification through DHS. Is the Provider Web Portal different?

A.

The current Web-based service is through First Health’s Automated Information System (AIS), which will no longer be available once the new system goes live.

The new Provider Web Portal replaces the Web AIS and provides many additional tools, including online claims and prior authorization requests, online Prioritized List inquiries, and the ability to update your office’s demographic information, such as office hours, address(es) and whether you are accepting new patients.

The telephone-based AIS is also going away. It will be replaced by the Automated Voice Response (more information is available).

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, currently provided free from DHS through a contract with First Health. 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 kind of training will be available?

A.

DHS and EDS are working together to plan classroom trainings throughout the state in 2008. These trainings will help prepare providers for the transition to the replacement MMIS. The Oregon MMIS Implementation training will include an overview of the replacement MMIS benefits and changes; information on billing via the Web, and more (see this link for more information).

Q.

Will there be training in rural areas?

A.

So far, DHS and EDS have identified 30 different sites for classroom training; many of these are in rural areas. Training will begin approximately 8-12 weeks prior to implementation.

Q.

Who will train new providers on the MMIS process?

A.

Once the replacement MMIS goes live, DHS will be responsible for educating providers on how to use the new system. This will be through updating provider billing resources/materials and continued guidance from your current DHS contacts. More details will be available as we approach the implementation date.

Q.

We submit claims electronically. Should we go to this training?

A.

Yes, we encourage all providers to attend training. The training provides information about many changes that are coming with the replacement MMIS, including information about the new tools available to you with the Provider Web Portal, which offers benefits to both electronic and paper billers.

Staff from DHS and from the MMIS contractor, EDS, will be available at all trainings to answer questions about the new system. More information about the training is available.

Q.

Where can I learn about how we will submit claims for prescriptions in the new system?

A.

DHS has specific sessions set aside specifically for pharmacy providers. They provide information about changes to Point of Sale, prior authorization, and more. The next sessions are Sunday, July 27, in Eugene, and Sunday, August 17, in Portland. More information is available (see “POS, PBM and MMIS Training for Pharmacy Providers”).

Q.

We don’t bill; our clearinghouse does. Do we need to go to this training?

A.

If you don’t bill, but want to learn about changes to verifying eligibility, changes to the Medical ID, and tools that your office can use through the Provider Web Portal, this training will be helpful.

Most of the training will be of interest to billers and those who would coordinate Provider Web Portal logins for their staff. Providers who currently bill DHS, should register at least one billing staff person so they can take the training material back to the office to share with others. If a billing service or clearinghouse bills for you, encourage them to attend.

Q.

I won’t be able to attend the MMIS training in my area. Can I go to another city?

A.

You can go to any of the statewide trainings that fit your schedule. You are not required to go to the training that is nearest you.

If you are unable to attend any of the statewide training sessions, you can also look at the training material on the Web. DHS will also post a self-paced, Web-based training course on the DHS Learning Center in August.

Q.

How will the replacement MMIS help Medicaid clients?

A.

The replacement MMIS will provide up-to-date information about physicians and other medical providers in an online directory that Medicaid clients, as well as their advocates, home-care providers and family members can access. You can find out more information at this this link.

Q.

Will I still have my 6-digit "DMAP" provider number?

A.

Yes. All currently enrolled providers with a 6-digit “DMAP” provider number will retain this number in the replacement system. However, use of this number will not be the same due to the implementation of NPI for covered providers.

Q.

Will payment be by electronic transfer only?

A.

Only if the provider requests this method of payment. DHS will provide two options of payment: Paper check or Electronic Funds Transfer (EFT, or direct deposit). Click here for more information about EFT.

Q.

How will we get Remittance Advices (RAs) in the replacement MMIS?

A.

You will still have the same options for receiving RAs: The paper RA and the electronic 835 transaction.

Q.

I currently must have a business account for EFT. Will this still be necessary in the new system?

A.

In the replacement MMIS, you will be able to have your EFT go to a personal or business checking or savings account.