What you can do now

This page outlines the major changes managed care organizations (MCOs) will see as a result of implementing the replacement MMIS, and what you can do to prepare for the change.

Above all, keep informed by reading all MMIS communications you receive from DHS and make sure to attend the monthly MMIS-MCO Workgroup meetings. You can also eSubscribe to receive an e-mail alert  each time the MMIS Provider Resources Web site is updated.

• Electronic Data Interchange (EDI) testing
• Electronic Funds Transfer (EFT)
• Eligibility verification
• National Provider Identifier (NPI)
• Provider Web portal

For more information on benefits and changes related to electronic data interchange, go to the EDI page of the MMIS Provider Resources site.

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Electronic Data Interchange (EDI) testing

Before the replacement MMIS goes live, DHS must ensure that incoming transactions are HIPAA-compliant and that existing EDI submitters (providers and trading partners) are prepared to follow all revised or new billing procedures. To do this, DHS will notify existing EDI submitters that they need to re-test their EDI transactions with DHS.

• If you are a current EDI submitter and DHS requires you to re-test, make sure re-testing with DHS is completed by the deadline. For more information about re-testing, go to the EDI page of this site.
• If you are a current EDI submitter and you do not receive notification to re-test, contact DHS EDI Support Services.

Once the replacement MMIS goes live, DHS will support all standard HIPAA claims transactions.

Electronic Funds Transfer (EFT)

If you currently receive your payments via EFT (direct deposit), your EFT information will be automatically converted into the replacement MMIS system so that electronic payments will continue after implementation.

Eligibility verification

The replacement MMIS will provide a one-time, wallet-sized Medical Care ID card that will replace the current 8.5 x 11 ID card. The Medical ID is not a guarantee of eligibility, and the new wallet-sized ID will not provide eligibility or enrollment information on the card.

• Before providing services, all providers must continue to verify the client's eligibility to confirm that the client receiving services is, in fact, an eligible individual on the date of service. Date of service is defined as the date services are rendered.
• Make sure your contracted providers are able to use one of the existing eligibility verification methods listed here. (The new AVR and Web-based eligibility verification options will replace the current AIS.)

National Provider Identifier (NPI)

The replacement MMIS will accommodate the National Provider Identifier for all eligible providers. To ensure appropriate claims processing and payment, all eligible providers must register their NPI and taxonomy code(s) with DHS as soon as possible. New providers are also required to submit their NPI and taxonomy code(s) when enrolling with DHS.

• If you have providers who provide services to DHS clients that are eligible for an NPI and haven’t submitted their NPI to DHS, click here for more information.

Provider Web Portal

When the replacement MMIS goes live, MCOs will be able to review submitted encounters, verify eligibility, check OHP diagnosis and procedure pairs on the Health Services Commission’s Prioritized List of Health Services, and more via the secure Provider Web Portal.

• To take advantage of the new Oregon MMIS Web functionality, your computer system will need an Internet connection and a compatible Internet browser.
• If you have 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.
• More information about the benefits of the replacement MMIS, including Provider Web Portal benefits, can be found here.