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 DHS’s 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.